NON MUSCLE INVASIVE BLADDER CANCER TREATMENT

Approximately 70 percent of all new cases of bladder cancer are classified as non-muscle invasive, also called superficial bladder cancer. The initial treatment for this stage of bladder cancer is surgical removal of the tumor through a cystoscope (called TURBT). This is often followed by adjuvant (additional) therapy, which reduces the chances of the cancer recurring. Of these, approximately 20 to 25 percent of initially non-muscle invasive cancers will progress to invasive types during the person's lifetime. Recurrence is frequent depending on the presence of several established risk factors: multiplicity, T dimension, prior recurrence. Depending to the risk category patients are directed to different adjuvant treatments. In low risk categories the standard is one shot treatment with chemotherapy without any maintenance therapy. In intermediate risk patients, adjuvant induction therapy and maintenance chemotherapy or immunotherapy for at least one year is recommended. In high risk patients adjuvant induction and maintenance immunotherapy until 3 years is considered the best strategy. In this review data on the different drugs used in this setting will be discussed. The remaining 30 percent of bladder cancers are muscle invasive, and generally require surgery to remove the bladder (cystectomy) and the surrounding organs.