Powierzchowny rak pęcherza moczowego

Marek Urban, Krzysztof Bar, Robert Klijer, Radosław Starownik

Summary
Bladder cancer, for therapeutic purposes is devided into two groups: superficial and muscle invasive tumor.
Superficial bladder cancer (SBC), which constitutes about 80% of all bladder tumors, is not an uniform group. We can distinguish: papillary tumors confined to the mucosa (Ta), tumors invading lamina propria (T1) and flat, high-grade cancers confined to the mucosa (Tis- tumor in situ or Cis-carcinoma in situ).
The character of SBC is a high tendency to recur. The risk of progression to muscle invasive tumors is different for particular types of SBC. The course of the disease can be predicted with considerable probability by means of analysis of the clinical risk factors of SBC, such as stage, grade, size, multifocality, location and recurrence rate. Based on prognostic factors, SBC can be devided into 3 risk groups: low-risk tumors(single,Ta, G1, <3 cm in diameter), high-risk tumors (T1, G3, multifocal and highly recurrent, Tis) and intermediate (all other tumors).
The standard of treatment of all SBC tumors should be one single bladder instilation with cytostatic administrated within 6 hours after TURBT. Patients with intermediate-risk tumors should also be treated with a course of maintenance instillation with chemotherapeutic agents. The therapeutic method of choice in high-risk tumors is intravesical BCG-therapy. The indications for cystectomy in SBC are: failure of conservative treatment, multifocal tumors, which cannot be removed by means of TURBT. Moreover, many urologists suggest early cystectomy in high-risk T1G3 tumors.

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