[Diagnosis of and therapy for non-muscle-invasive bladder cancer - state of the art].
Around 80 % of newly diagnosed bladder cancers are confined to the mucosa and staged as non-muscle-invasive bladder cancer (NMIBC) (Ta, T1, Cis). These tumours appear to segregate into different main molecular pathways with extremely variable prognoses. The standard treatment for NMIBC is transurethral tumour resection (TUR) with Re-TUR and adjuvant intravesical chemotherapy or intravesical immunotherapy in most cases. Several developments associated with diagnosis such as the usefulness of the new WHO grading classification, the benefit of photodynamic diagnosis (PDD) or narrow band imaging (NBI), as well as the clinical value of tumour markers are discussed. Therapy for NMIBC includes monopolar or bipolar TUR. Subsequent instillation therapy is given according to the risk stratification. Several promising new substances as well as device-assisted procedures such as thermochemotherapy or EMDA are discussed. The additional information gained by PDD obviously leads to a better diagnosis and treatment of all NMIBC. Routine IVU does not seem necessary. The value of diagnostic urine tests is still insufficiently defined. Several new aspects concerning prognostic markers are presented. While early chemotherapy instillation seems sufficient in low-risk tumours and BCG is the standard treatment for high-risk disease, the literature about treatment of intermediate risk tumors is still conflicting. Especially problematic is the case of recurrent disease after intravesical therapy in intermediate and high-risk patients. The question as to what has to be done in failure after BCG is discussed. Cystectomy is a safe option but other approaches are potential alternatives.
Kausch von Schmeling
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Klinik für Urologie, Universität zu Lübeck, UK S-H, Lübeck. Ingo.Kausch@uk-sh.de
D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001500:BCG Vaccine / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D015653:Cystectomy; D003558:Cystoscopy; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents; D001500:BCG Vaccine