BCG vaccine in superficial bladder cancer.

The most effective form of immunotherapy for solid tumours is still poorly understood The main risks from superficial bladder cancer are that it may recur or that it may progress to invasive disease with a high mortality. Immunotherapy with live BCG vaccine was shown to be an effective treatment as long ago as 1976,1 and the vaccine is still the only intravesical agent to have been shown to reduce both of these risks.2 Factors that increase the risk of progression are high tumour grade, invasion of the lamina propria, and the presence of carcinoma in situ.3 The main indications for the use of BCG vaccine in Britain are treatment of carcinoma in situ of the bladder; treatment of residual superficial papillary tumour; and prophylaxis against recurrence of superficial tumours and against progression after resection of a tumour. No one questions the use of BCG vaccine for diffuse carcinoma in situ. This condition is difficult to eradicate by resection--indeed, if treated by surgery alone it progresses to invasion of the …