TABLE OF CONTENTS Ratha Mahendran a , Shih-Wee Seow a , Boon-Kian Lim b, Jing-Ying Yong b , Sim-Mun Tham a , Boon-Huat Bay c and Yuan-Kun Lee b
Department of Surgery a , Microbiology b and Anatomy c , Faculty of Medicine, National University of Singapore, Singapore 117597
Bladder cancer is the ninth most common cancer in Singapore [1] and the seventh most common cancer amongst males worldwide [2]. The frequency in men is three times that in women.
More than 90% of bladder cancers are transitional cell carcinomas and the majority present as superficial (80%) rather than invasive (20%). Though not life threatening bladder cancer is characterized by frequent recurrences which may progress to more malignant muscle invasive disease (10 30% of patients). Some 50% of patients with muscle invasive disease die of metastases within 5 years [3].
BCG has been used as a vaccine for tuberculosis from 1921 but it was only in 1935 that it was first used to treat cancer. However, BCG gained popularity as a therapeutic agent for cancer from the late 1950 s to early 1960 s mainly due to the work of Coe and Feldman [4] who showed that the bladder was capable of mounting an immune response. Zbar et al. [5] also showed that intra-tumoural BCG could cure animals of implanted tumours. In 1976, Morales et al. [6] reported that BCG eliminated visible tumours and prevented recurrences in all but 1 out of 9 patients with superficial bladder cancer. Subsequently a number of prospective trials...
