Abstract
Superficial bladder cancer encompasses patients with stage Ta T1 tumors and patients with carcinoma in situ (CIS). The natural history or treatment-related prognosis of these patients varies considerably from one patient to the next based on the patients clinical and the tumor's pathological characteristics. Based on a review of the literature, the most important prognostic factors for recurrence are the prior recurrence rate, number of tumors, and tumor size; whereas for progression, the most important prognostic factors are the T category, grade, and presence of CIS. Treatment with intravesical bacillus Calmette-Guerin reduces both the risk of recurrence and the risk of progression, and is the treatment of choice in high-risk papillary tumors and in patients with CIS. Assessment of a patient's prognostic factors and his or her risk of recurrence and progression is a prerequisite for determining the most appropriate treatment and frequency of follow-up for a given patient.
Highlights
Bladder cancer is a multifocal disease that may pass through different stages of development, from atypia to dysplasia to overt tumor due to the cumulative exposure to a variety of potential carcinogens and the continual onslaught of the carcinogenic process
bacillus Calmette-Guerin (BCG) is the treatment of choice in patients at high risk of recurrence and especially in those patients who are at high risk of progression
Prognostic factor studies have shown that patients labeled as having superficial bladder cancer have, a quite heterogeneous prognosis
Summary
Bladder cancer is a multifocal disease that may pass through different stages of development, from atypia to dysplasia to overt tumor due to the cumulative exposure to a variety of potential carcinogens and the continual onslaught of the carcinogenic process. Taken together as a group, patients with superficial bladder cancer have a median survival of approximately 10 years, the vast majority of deaths are not due to bladder cancer[6]. Their natural history is characterized by the disease’s propensity to recur as a superficial tumor and to progress to muscle-invasive disease, stage T2 or higher, which is associated with a much higher risk of death due. Despite having a long median survival, grouping all these patients together under the umbrella “superficial” bladder cancer is misleading since, as described below, one patient’s prognosis can be quite different than that of another patient. When considering a patient’s natural history or prognosis, it is necessary to consider his or her clinical and pathological factors, one must take into account the potential effect of the intravesical treatment received: chemotherapy or immunotherapy
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