Bladder cancer is subdivided into four groups: 1) Superficial high-grade disease (TIS); 2) superficial disease (T1); 3) superficially invasive into the muscle (T2); and 4) tumor extending into deep muscle and/or perivesical fat (T3A/T3B). Standard therapy for superficial disease confined to the mucosa or submucosa consists of transurethral resection and intravesical chemotherapy (thiotepa, mitomycin C, BCG). Recurrence rates may range from 30%-85% depending upon the grade of tumor and multiplicity of lesions. The concept of a full field defect in patients with carcinoma in-situ in association with a solitary papillary tumor is supported by the high incidence of invasive disease developing within two years following resection alone. Five-year survival rates for patients developing invasive disease (T2/T3A) range from 31%-52%. Early control of superficial disease offers a potential advantage towards reduction of the overall death rate in bladder malignancy. Carcinoma in-situ refractory to intravesical chemotherapy is a particularly troublesome clinical entity, as patients are at high risk for the development of invasive disease and may require removal of the urinary bladder (cystectomy). Recent work with hematoporphyrin derivative (HpD) sensitized photodynamic therapy of the bladder mucosa suggests high cytotoxic effect, but low systemic toxicity. This modality may permit treatment of superficial carcinoma of the bladder as well as carcinoma in-situ which may permit bladder preservation with cure of tumor.
