title: Management of carcinoma in situ of the bladder: the case for surgical management.
abstract: In view of the foregoing observations of the distinctive characteristics of in situ cancer of the bladder, our position on this disease is as follows. The variability in the biologic activity and in the chronicity of carcinoma in situ of the bladder is acknowledged. However, it is clear that most, if not all, cases of invasive bladder cancer represent a progression of the in situ stage, which is usually currently detectable in an undifferentiated or anaplastic cellular state. Until the advent of biochemical predictors of unqualified reliability for the identification of the crucial time of invasion, we recommend radical cystectomy for cure of in situ carcinoma provided the patient is a reasonable surgical risk, is severely symptomatic, has histologic evidence of extension of the lesion into the vesical neck, urethra, or terminal ureter, and has either histologic or cytologic persistence of cancer after a 6 to 12 month course of intravesical chemotherapy. Most patients with incidentally discovered or asymptomatic in situ carcinoma seem to have a more focal variety of the disease. Under these circumstances, a 6 to 12 month trial of intravesical chemotherapy would be reasonable if scrupulous assessment of the progress of the cancer were possible.
mesh_terms: D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*