Bladder Carcinoma In Situ: Diagnosis and Treatment

Presentation and Prognosis

Bladder carcinoma in situ (CIS) can present as either single or multiple lesions, though multifocal disease is more common and carries a worse prognosis, according to the National Comprehensive Cancer Network 1, 2
Multifocal CIS lesions are identified as a particularly high-risk feature requiring more aggressive management, as stated by the National Comprehensive Cancer Network 1
Multifocal CIS lesions are specifically categorized as high-risk disease that may warrant early cystectomy rather than repeat TURBT, as recommended by the National Comprehensive Cancer Network 1

CIS is often missed by standard white light cystoscopy because it appears as flat lesions that can range from normal-appearing mucosa to areas indistinguishable from inflammation, according to the National Comprehensive Cancer Network 3
Blue light cystoscopy detects CIS at significantly higher rates than white light cystoscopy (40.8% more CIS lesions detected; P<.001), as reported by the National Comprehensive Cancer Network 3, 4
Multiple selective and/or random biopsies should be performed when CIS is suspected or known, as recommended by the National Comprehensive Cancer Network 5
Additional biopsies adjacent to any papillary tumor are necessary, according to the National Comprehensive Cancer Network 5, 6

Standard therapy for CIS is resection followed by intravesical BCG therapy (category 1 recommendation), given once weekly for 6 weeks, as stated by the National Comprehensive Cancer Network 1, 7
For patients with multifocal high-risk disease, early cystectomy may be preferred over bladder preservation, as recommended by the National Comprehensive Cancer Network 1