Superficial urinary bladder cancer. Results from the Finnbladder studies and a review on instillation treatments.

At present, about 80% of primary, newly diagnosed urinary bladder cancers are local (NOMO), i.e., potentially curable. Not less than two thirds of all are superficial cancers (TIS, Ta, T1), and thus subjects of conservative, local treatments. Carcinoma in situ (TIS/CIS) has three clinical manifestations: 1) primary TIS is found without a previous history of bladder cancer, 2) secondary TIS is found during the follow-up of an earlier cancer, and 3) concomitant TIS is found simultaneously with a papillary tumour. Otherwise, there are controversial diagnostic and therapeutic attitudes on TIS. Concerning the primary diagnosis and grading, the reliance on cytological possibilities varies in separate centres. "Wait-and-see policy" might be justified in mild dysplasia Grade 1, whereas both the TIS Grade 2, and TIS Grade 3, are real malignancies which need a more effective treatment than transurethral resection (TUR) alone. Under a close control, intravesical chemo- and immunotherapy with doxorubicin (ADM), mitomycin C (MMC) and bacillus Calmette-Guérin (BCG) offer an alternative to cystectomy. However, it remains to be seen in the future whether combined or alternating instillations will give a still better return. By contrast, the principal treatment of visible superficial (Ta and T1) cancer is TUR, which can be easily repeated. Most recommended strategy for Grade 3 T1 cancer seems to be the same. Anyhow, the high frequency of recurring tumours and the tendency to simultaneous progression in specific categories of Ta-T1 cancer have led to adjuvant prophylactic instillation treatments. Currently, both local cytostatics (ADM and MMC in the present series), and immunoagents (BCG) have been proven safe.(ABSTRACT TRUNCATED AT 250 WORDS)