Skip to main content
SpringerLink
Log in

Clinical Scenario: Initial CIS

Case: 55-Year-old man with CIS and high-grade Ta tumors who received a 6-week induction course of BCG

  • Chapter
  • First Online:
Management of Bladder Cancer

  • 1471 Accesses

Abstract

Management of patients with intermediate- to high-risk non-muscle invasive bladder cancer (large, multiple tumors, presence of carcinoma in situ, and high-grade disease) is centered on optimal intravesical bacillus Calmette-Guerin therapy. Improvements in technology, such as photodynamic diagnosis combined with traditional techniques of complete resection and thorough staging can improve outcomes. Timely surveillance with cystoscopy is necessary, and urinary markers such as fluorescence in situ hybridization can further help risk-stratify those most likely to fail treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BCG:

Bacillus Calmette-Guerin

CIS:

Carcinoma in situ

EORTC:

European Organization for Research and Treatment of Cancer

FDA:

Food and Drug Administration

FISH:

Fluorescence in situ hybridization

HAL:

Hexaminolevulinate

NMIBC:

Non-muscle Invasive Bladder Cancer

PDD:

Photodynamic diagnosis

SWOG:

Southwest Oncology Group

TUR:

Transurethral resection

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  2. Heney NM, Ahmed S, Flanagan MJ, et al. Superficial bladder cancer: progression and recurrence. J Urol. 1983;130(6):1083–6.

    CAS  PubMed  Google Scholar 

  3. Sylvester RJ, Brausi MA, Kirkels WJ, et al. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–73.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Sylvester RJ, van der MA, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168(5):1964–70.

    Article  CAS  PubMed  Google Scholar 

  5. Sylvester RJ, van der Meijden AP, Witjes JA, Kurth K. Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials. J Urol. 2005;174(1):86–91. discussion 91–2.

    Article  CAS  PubMed  Google Scholar 

  6. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49(3):466–5. discussion 466–477.

    Article  PubMed  Google Scholar 

  7. Fernandez-Gomez J, Madero R, Solsona E, et al. Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol. 2009;182(5):2195–203.

    Article  PubMed  Google Scholar 

  8. Lamm DL, Blumenstein BA, Crissman JD, et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol. 2000;163(4):1124–9.

    Article  CAS  PubMed  Google Scholar 

  9. Reichert DF, Lamm DL. Long term protection in bladder cancer following intralesional immunotherapy. J Urol. 1984;132(3):570–3.

    CAS  PubMed  Google Scholar 

  10. Herr HW. Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol. 1998;16(3): 1099–102.

    CAS  PubMed  Google Scholar 

  11. Oddens J, Brausi M, Sylvester R, et al. Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guerin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol. 2013;63(3):462–72.

    Article  PubMed  Google Scholar 

  12. Ramirez-Backhaus M, Dominguez-Escrig J, Collado A, Rubio-Briones J, Solsona E. Restaging transurethral resection of bladder tumor for high-risk stage Ta and T1 bladder cancer. Curr Urol Rep. 2012;13(2):109–14.

    Article  PubMed  Google Scholar 

  13. Herr HW. Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus Calmette-Guerin therapy. J Urol. 2005;174(6):2134–7.

    Article  PubMed  Google Scholar 

  14. Herr HW, Donat SM. Quality control in transurethral resection of bladder tumours. BJU Int. 2008;102(9 Pt B):1242–6.

    Article  PubMed  Google Scholar 

  15. Jocham D, Stepp H, Waidelich R. Photodynamic diagnosis in urology: state-of-the-art. Eur Urol. 2008;53(6):1138–48.

    Article  CAS  PubMed  Google Scholar 

  16. Burger M, Grossman HB, Droller M, et al. Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol. 2013;64(5):846–54.

    Article  PubMed  Google Scholar 

  17. Herr HW, Sogani PC. Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol. 2001;166(4):1296–9.

    Article  CAS  PubMed  Google Scholar 

  18. Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology. 2003;61(1):109–18. discussion 118.

    Article  PubMed  Google Scholar 

  19. Konety BR. Molecular markers in bladder cancer: a critical appraisal. Urol Oncol. 2006;24(4):326–37.

    Article  CAS  PubMed  Google Scholar 

  20. Gudjonsson S, Blackberg M, Chebil G, et al. The value of bladder mapping and prostatic urethra biopsies for detection of carcinoma in situ (CIS). BJU Int. 2012;110(2 Pt 2):E41–5.

    Article  PubMed  Google Scholar 

  21. Witjes JA, Redorta JP, Jacqmin D, et al. Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations. Eur Urol. 2010;57(4):607–14.

    Article  PubMed  Google Scholar 

  22. Kamat AM, Karam JA, Grossman HB, Kader AK, Munsell M, Dinney CP. Prospective trial to identify optimal bladder cancer surveillance protocol: reducing costs while maximizing sensitivity. BJU Int. 2011;108(7):1119–23.

    Article  PubMed  Google Scholar 

  23. Bubendorf L, Grilli B. UroVysion multiprobe FISH in urinary cytology. Methods Mol Med. 2004;97:117–31.

    CAS  PubMed  Google Scholar 

  24. Sarosdy MF, Schellhammer P, Bokinsky G, et al. Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer. J Urol. 2002;168(5):1950–4.

    Article  CAS  PubMed  Google Scholar 

  25. Whitson J, Berry A, Carroll P, Konety B. A multicolour fluorescence in situ hybridization test predicts recurrence in patients with high-risk superficial bladder tumours undergoing intravesical therapy. BJU Int. 2009;104(3):336–9.

    Article  PubMed  Google Scholar 

  26. Highshaw RA, Tanaka ST, Evans CP. deVere White RW. Is bladder biopsy necessary at three or six months post BCG therapy? Urol Oncol. 2003;21(3):207–9.

    Article  PubMed  Google Scholar 

  27. Kamat AM, Dickstein RJ, Messetti F, et al. Use of fluorescence in situ hybridization to predict response to bacillus Calmette-Guerin therapy for bladder cancer: results of a prospective trial. J Urol. 2012;187(3):862–7.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Mengual L, Marin-Aguilera M, Ribal MJ, et al. Clinical utility of fluorescent in situ hybridization for the surveillance of bladder cancer patients treated with bacillus Calmette-Guerin therapy. Eur Urol. 2007;52(3):752–9.

    Article  PubMed  Google Scholar 

  29. Raitanen MP, Aine R, Rintala E, et al. Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicenter analysis. Eur Urol. 2002;41(3):284–9.

    Article  PubMed  Google Scholar 

  30. Hara T, Takahashi M, Gondo T, et al. Discrepancies between cytology, cystoscopy and biopsy in bladder cancer detection after Bacille Calmette-Guerin intravesical therapy. Int J Urol. 2009;16(2):192–5.

    Article  PubMed  Google Scholar 

  31. Gayed BA, Seideman C, Lotan Y. Cost effectiveness of fluorescence in situ hybridization in patients with atypical cytology for the detection of urothelial carcinoma. J Urol. 2013;190(4):1181–6.

    Article  CAS  PubMed  Google Scholar 

  32. Skacel M, Fahmy M, Brainard JA, et al. Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. J Urol. 2003;169(6):2101–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    Sima P. Porten M.D., M.P.H. & Colin P. Dinney M.D.

Authors
  1. Sima P. Porten M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Colin P. Dinney M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sima P. Porten M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA

    Badrinath R. Konety

  2. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Porten, S.P., Dinney, C.P. (2015). Clinical Scenario: Initial CIS. In: Konety, B., Chang, S. (eds) Management of Bladder Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1881-2_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1881-2_19

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1880-5

  • Online ISBN: 978-1-4939-1881-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation