Pathology and genetics of tumours of the urinary system and male genital organs

Prognostic factors for recurrence and followup policies in the treatment of superficial bladder cancer: report from the British Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party).

Superficial bladder cancer includes tumors confined to the mucosa and lamina propria. They may be papillary or sessile. Tumors confined to the mucosa include papillomas, papillary carcinomas, or carcinoma in situ. Therapy must be individualized for each patient taking into consideration the histologic type, cytologic grade, location, number, prior history, and presence of atypia or carcinoma in situ in other areas of the bladder. Although the five-year survival rates are good (62-88 percent), the 48-70 percent incidence of subsequent tumors requires constant surveillance. This high incidence is primarily due to the multifocal origin of urothelial tumors, but implantation of tumor cells following local resection may be a contributing factor. Current efforts to reduce this recurrence rate emphasize intravesical chemotherapy. Thio-tepa and epodyl are effective in eradicating one-third of tumors when used for definitive therapy. Most studies demonstrate a reduction in the recurrence rate when they are initiated following endoscopic resection of all visible tumor. A number of other drugs are being investigated for both definitive and prophylactic intravesical chemotherapy. Surgical procedures consist of transurethral resection, transvesical radium implantation, segmental cystectomy, and cystoprostatectomy. Each procedure has its own indications, and the surgeon must be discriminating in their use.

The management of superficial bladder cancer.

https://www.urologic.theclinics.com/article/S0094-0143(05)70229-9/pdf

THE NATURAL HISTORY OF BLADDER CANCER: Implications for Therapy

Significance of Bladder Biopsies in Ta,T1 Bladder Tumors: A Report from the EORTC Genito-Urinary Tract Cancer Cooperative Group

The concept that most bladder carcinomas arise from a widespread reaction of urothelial cells to various carcinogenic stimuli is widely accepted. The evidence for this theory rests largely on retrospective evaluations of nontumorous urothelium obtained from patients with concomitant or sinecomitant bladder cancers. A prospective surveillance study of patients with bladder cancer has been conducted at the University of Tennessee Center for the Health Sciences, a collaborating institution of the National Bladder Cancer Collaborative Group-A, to determine the frequency, distribution, and biologic significance of hyperplasia, dysplasia, carcinoma in situ (CIS), and carcinoma in the cystoscopically unremarkable urothelium of patients with carcinoma of the bladder.



Multiple mucosal biopsies were obtained at cystoscopy from preselected sites in 64 patients. Specimens were collected both when tumors were visible and when no tumor was seen. Of the 657 evaluable specimens, 94 (14.3%) were positive for either hyperplasia, dysplasia, carcinoma in situ, or carcinoma (invasive and/or papillary, noninvasive). In general, the frequency of positive biopsies increased with advancing histologic grade of the primary neoplasm. When possible, incomplete resection of the primary tumor was taken into consideration; there was no statistically significant difference between frequency of positive specimens collected from sites adjacent to versus distant from the original neoplasm. Patients were no more likely to have abnormal urothelium when a tumor was cystoscopically visible than when no tumor was apparent, but lesions occurring in the presence of a tumor tended to be of greater histologic severity. The biologic significance of flat, noninvasive urothelial lesions (hyperplasia, dysplasia, CIS) can be determined only after longer periods of observation, but preliminary results indicate a borderline statistical significance (p ≅ 0.10) for these abnormalities in the prediction of subsequent recurrence or new occurrence of bladder cancer.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%28197909%2944%3A3%3C1050%3A%3AAID-CNCR2820440337%3E3.0.CO%3B2-N

"Normal" urothelium in patients with bladder cancer: a preliminary report from the National Bladder Cancer Collaborative Group A.

The pathologist plays a key role in the detection and diagnosis of bladder cancer, as well as in the development of strategies for the clinical management of this disease by the urologist. In order to make appropriate decisions, the urologist needs help from the pathologist in determining: 1) whether or not a bladder tumor is present; 2) if present, its histologic type, grade, depth of invasion and evidence of lymphatic or blood vessel invasion; 3) whether or not there are associated neoplastic lesions elsewhere in the bladder -or elsewhere in the lower urinary tract; and 4) if some therapeutic modality has been directed toward the neoplastic tissue, the completeness of tumor removal or destruction. It is recommended that the WHO classification of bladder tumors be used by pathologists in their reports to facilitate communication among pathologists, urologists, radiation therapists, medical oncologists, and others involved in the management of bladder cancer patients. In addition, the pathologist should make a definite statement regarding the presence or absence of muscle tissue in every bladder biopsy specimen containing tumor. After one or more superficial tumors are identified by the urologist and treated by transurethral means, management of the patient will depend not only on the microscopic evaluation of the resected tumor but also on an accurate assessment of the neoplastic potential of the remaining epithelium. The cytopathologic examination of urine samples or bladder washings aids this assessment.

The Pathology of Human Bladder Cancer

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"Normal" urothelium in patients with bladder cancer: a preliminary report from the National Bladder Cancer Collaborative Group A.

The Pathology of Human Bladder Cancer