Acceptance of the value of urinary cytology in transitional cell carcinoma has been mixed. Over-all accuracy is only fair to good and the results in mass screening are poor. However, cytology can be valuable in the serial evaluation of selected patients by the collection of multiple specimens. It is an important adjunct in upper tract lesions, in carcinoma in situ and in the evaluation of the patient with unexplained hematuria. Herein we analyze patients with transitional cell carcinoma of the urothelium with special reference to the use of cytology irrigation specimens from the bladder and the renal pelvis as an initial diagnostic tool and as an adjunctive technique for the evaluation of recurrence.
Recurrent transitional cell carcinoma was treated with prophylactic intravesical thio-tepa in 22 cases. Group 1 patients were treated with 30 mg. twice daily for the first 3 days postoperatively. Group 2 patients were given additional treatment at increasing intervals indefinitely. Before therapy control patients averaged 1 recurrence every 9.5 months. Group 1 patients averaged 1 recurrence per 33 mpnths. Group 2 patients averaged 1 recurrence per 41 months. Leukopenia occurred in only 2 patients. Thio-tepa can be given safely in the immediate postoperative period and is effective in decreasing the recurrence rate of superficial bladder tumors.
A patient with known transitional cell carcinoma of the bladder and hypercalcemia was evaluated for urinary prostaglandin levels when no bone metastases or elevated parathormone levels could be demonstrated. Urinary levels of prostaglandin E metabolite were assessed in relation to serum and urinary calcium levels during treatment. The serum calcium levels decreased from the 13.0 mg. per cent range whenever the rpimary tumor was manipulated (transurethral resection) or when other treatments directed at the tumor were used (radiation therapy and chemotherapy). Serum and urinary calcium levels, and urinary prostaglandin E metabolite decreased when 3 gm. aspirin were given daily. These data suggest that the somewhat unusual hypercalcemia in our patient was caused by a prostaglandin-secreting transitional cell carcinoma. Prostaglandin-secreting tumors are reviewed herein.
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