Carcinoma In Situ
From Kidney Cancer Resource
Contents |
Overview
Carcinoma In Situ of the urinary bladder abreviates as CIS of the urinary bladder or just CIS
This can occur in various types of cancer including, most notably, bladder cancer, breast cancer and cancer of the cervix.
Carcinoma In Situ of the urinary bladder, a form of bladder cancer, is a flat carcinoma of the urothelium. CIS accounts for around 10% of bladder cancer which strikes some 275,000 people per annum world wide, of whom some 108,000 die of the disease or complications from the disease.
CIS may develop alone but papillary tumors does not preclude CIS as they may present together. Carcinoma In Situ can be difficult to accurately diagnose as patients of both genders may present with irritative symptoms when urinating, this being a common problem in a urology! Usually the patient has microscopic or gross haematuria, this can easily be misdiagnosed as a bladder infection and are too often treated as such.
Cystoscopy may show an area with a red velvety appearance similar to inflammation, unfortunately CIS is not always visible. Standard diagnostic tests include a urine cytology and/or one of the available bladder cancer markers. These various tests are very sensitive in detecting Carcinoma In Situ. Biopsies are essential for catagoric diagnosis.
Treatments
CIS tends to respond to various chemotherapies and immunotherapies. The chosen treatment is administered intravesically. TUR is not usually suitable for the treatment of CIS, although the usual first treatment for papillary tumour.
The commonest treatment used intravesical to treat CIS is Bacillus Calmette-Guérin (BCG). This is a type of immunotherapy. Serial instillations of BCG, which is tuberculosis vaccine, has been shown to effectively eradicate CIS for 70% of patients also to retard recurrence and progression.
The commonest Chemotherapeutic treatments are mitomycin-C (Mutamycin), gemcitabine (Gemzar), thiotepa, and doxorubicin (Adriamycin) cwhich an be instilled into the bladder to treat this disease. Interferon-alpha (IFN-alpha) is an immunotherapeutic treatment that can be used in conjunction with BCG in some patients.
The efficacy of these treatments tend to be most satisfactory in CIS which is diagnosed early.
CAVEAT
CIS which has invaded the lamina propria and beyond is considered to fall into the same category as a papillary cancer. It should thus be treated accordingly.
In 20% of patients Intravesical treatments are not effective. In these patients cancer invades the bladder wall. In these cases cystectomy or a combination of radiation therapy and chemotherapy may prove effective.
CIS is always confined to the epithelial surface of the urinary tract and can occur on any such tissue - thus on the surfaces of the renal pelvis, ureters, bladder wall and/or urethra. Thus CIS presents as a Ta tumor, although no specific stage designation is assigned.
Details
References
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