Report of a Follow-Up of Papillary Tumours of the Bladder1

Abstract

SUMMARY In this survey 504 cases of tumour of the urinary bladder have been classified into 365 of papilloma and 139 of early carcinoma, based in the main on the pathologists' diagnosis but also taking into account the surgeons' clinical assessment. In both groups, that is papillomata and early carcinomata which are confined to the epithelium of the bladder, about 70 per cent, recur after the first treatment, the recurrences behaving often over many years as benign non‐invasive tumours. In 6 per cent. of cases the original diagnosis of papilloma may have been erroneous, because within two years a frank carcinoma had developed. In nearly 7 per cent. of cases of papilloma an invasive cancer supervened after an interval of many years. The death rate from invasive cancer of all cases originally diagnosed as papilloma is 6 per cent. Death occurred at not less than five years and up to sixteen years following the initial diagnosis of papilloma. The death rate from invasive cancer of all cases originally diagnosed as early carcinoma is 7–9 per cent., death frequently occurring under three years. Death from invasive cancer occurs earlier in the early carcinoma group than in the papilloma group although in other respects the two groups are similar. Once a bladder has produced papillary tumours its subsequent behaviour is unpredictable, in that no further tumours may occur or tumours may arise at irregular intervals. The later tumours may be single or multiple, situated in any area and arising at any time. They may be benign or malignant. Nevertheless all these bladders must be recognised as having the potentiality to produce ultimately a tumour which will become invasive. Until the factors which produce this irregular and unpredictable pattern of tumour activity are discovered, this potentiality should never be under‐estimated. Vigilance by regular follow‐up cystoscopy and the effective treatment of recurrences undoubtedly helpS to control tumour growth, even though it cannot prevent new tumours from arising.

Prophylactic Chemotherapy of Superficial Transitional Cell Bladder Carcinoma: an EORTC Randomized Trial Comparing Thiotepa, an Epipodophyllotoxin (VM26) and TUR Alone

“…Superficial bladder tumors are usually treated by transurethral resection (TUR). How ever, 50-70% of these patients can be expected to have recurrence after complete resection of all visible lesions [1,5,9,14,22], The average recurrence interval ranges from 3 months up to 24 years [1,3]. This high incidence of subsequent tumors requires constant patient surveil lance and is primarily due to the multifocal origin of the urothelial tumors although implantation of tumor cells following local resection may also be a contributing factor Superficial bladder carcinomas represent tumors con fined to the mucosa and lamina propria.…”

The Value of Histologic Grading and Staging, Random Biopsies, Tumor and Bladder Mucosa Blood Group Antigens, in Predicting Progression of Superficial Bladder Cancer

“…Prognostic factors in patients with superficial bladder carcinoma can be classified into those which are obtained from the tumor and the bladder such as lamina propria invasion [1][2][3], tumor grade [4], tumor extension and recurrence rate [5], morphology of random mucosal biop sies [6][7][8], cell-surface A, B or O (H) blood-group antigens in the tumor [9][10][11][12] or tissue of random mucosal bladder biopsies [13,14], urinary cytology [15,16], abnormal chromosomes (markers) [17,18], DNA profile of the tumor [19,20], and urinary carcinoembryogenic antigen (CEA) [21][22][23], and those which represent host-defense factors, such as serum rheumatoid factors and urinary immunoglobulins [25].…”

Bladder tumours and smoking

“…The allotment of tumours into the categories '' papilloma " and '' carcinoma " followed the system used in a previous publication (Pyrah et al, 1964).…”