Carcinoma in situ (CIS)
CIS may affect the entire bladder mucosa. Therefore, the therapy directed to
its eradication must treat the entire mucosal surface. Bacille Calmette-Guerin
(BCG) is a weakened strain of Mycobacterium bovis-a cousin of the organism
primarily responsible for tuberculosis. When instilled as a solution into the
bladder-known as intravesical therapy-the body recognizes this foreign agent
and a powerful immune response ensues.
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Superficial invasive TCC
The primary treatment for superficial TCC is transurethral resection of the
bladder (TURB) or a transurethral fulguration. Using a similar instrument as
is used for cystoscopy, the urologist locates and visualizes the tumor within
the bladder. A small, wire loop that protrudes from the cystoscope and is
connected to an electrical source is used to carefully and precisely resect(cut
out) the tumor. On occasion the tumor may be so small or superficial that a
fulguration or simple burning of the abnormal tissue will suffice.
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Muscle Invasive TCC
Once a bladder tumor has penetrated into the muscle layer, the ability to
completely resect it via TURB becomes more difficult if not impossible. It is
often difficult to know from the resected specimen if the entire tumor has
been eradicated. Moreover, because such a deeply penetrating tumor would
necessitate a deeper resection, there is a correspondingly greater risk of
perforation of the bladder as well as major injury to adjacent organs.
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