How Is Carcinoma In Situ Treated?

The treatment of choice currently for carcinoma in situ is intravesical therapy with BCG. Carcinoma in situ in most cases is not adequately treated by resection alone because it tends to be located diffusely throughout the bladder. Sixty to 70% of patients with carcinoma in situ will respond to a standard course of BCG. Although encouraging, this obviously means that 30% to 40% of patients will fail a standard course, and thus most experts advise further therapy.

Some advocate two courses of BCG, whereas others prefer maintenance BCG for 3 years; urine is sent for cytology every 3 to 12 months. Also, periodic cystoscopy will need to be performed in the urologist’s office, and any suspicious lesions will need to be biopsied and examined under the microscope by a pathologist. Patients who fail to respond to BCG can be treated with other intravesical therapy. Interferon can be combined with BCG, or other chemotherapeutic agents like gemcitabine and valrubicin can be tried. If available, PDT can be considered . Ultimately, patients in whom carcinoma in situ persists despite intravesical therapy should consider having a cystectomy.