Which of the following is the most effective intravesical therapy for superficial bladder cancer-

Ans. is 'd' i.e., BCG Management of bladder cancerCystoscopy and transurethral resection or biopsy initially, any pt. with hematuria is examined by cystoscopy and any tumor seen is removed by transurethral resection (if possible) or biopsied.Further treatment decisions are made after tumor staging on histology. Such decisions are based on tumor stage (TNM), grade, size, multiplicity, and recurrence pattern.First see the staging (TNM)Tis - Ca in situTa - Ca confined to mucosa T1 - Ca confined to submucosa T2 -- Muscle invasion T3 - perivesical fat invasionT4 - invasion of adjacent structures (prostate, uterus, vagina, pelvic wall, abd. wall)Now the histological grading.There are 3 histological grades - grade 1, II & IIIThere is a strong correlation between tumor grading and tumor recurrence progression and survival.Cancer Stage Initial Treatment OptionsTis. Complete TUR followed by intravesical BCGTa (single, low-to-moderate grade, not recurrent)Complete. TURTa (large, multiple high-grade, or} recurrent T1 }. Complete TUR followed by intravesical chemo- or immunotherapyT2-T4Radical cystectomy .Neoadjuvant chemotherapy followed by radical cystectomy Radical cystectomy followed by adjuvant chemotherapy Neoadjuvant chemotherapy followed by concomitant chemotherapy and irradiationAny T, N+, M+Systemic chemotherapy followed by selective surgery or irradiationIntravesical therapy: Common agents used for intravesical therapy are Mitomycin C Thiotepa - BCG * Among these agents, BCG is the most effective.Treatment options for bladder cancers.