The Site of Recurrence of Non‐Infiltrating Bladder Tumours

Abstract

A study of 56 cases of non-infiltrating bladder tumour showed a striking difference in the distribution within the bladder of the primary and the recurrent tumours. More than three-quarters of the primary tumours were confined to a restricted area near a ureteric orifice whereas only one-fifth of recurrent tumours were found in this site. By far the commonest site for recurrent tumours was the postero-superior wall of the bladder. Forty-five recurrent tumours formed in the air bubble region, a site in which no primary tumour was found in the whole series. The postero-superior wall of the bladder is subject to mild trauma and abrasion by the tip of an endoscope and the air bubble region is the recipient of hot gas produced by the diathermy. These gas bubbles may also convey detached tumour cells to the recipient site. Local trauma may encourage tumour formation either by producing a raw surface which allows implanation of tumour cells, or possibly also by reducing local resistance to the primary carcinogenic factor.

Bladder cancer cell implantation in reconstructed bladder in vitro: a model of tumour recurrence

“…That partial injury only to the most super®cial layer allows the implantation of tumour cells is important, because this phenomenon is in accordance with the clinical observation [4] that faint injuries made by endoscopic abrasion are associated with frequent tumour recurrence. In addition, the cross-sectional appearance of a minute tumour growing only at the site of the injured mucosa surrounded by normal epithelium suggests that implantation of the tumour has only just begun.…”

“…They speculated that this could be caused by cell fragments which separated from the tumour and¯oated to the vault, assisted by adherent gas bubbles, during TURBT. Page et al [4] presented a similar report and suggested that there were many recurrences at the posterosuperior wall of the bladder, perhaps because this part was easily injured at the time of endoscopic surgery.…”

“…Second, incipient tumours that were invisible endoscopically at the time of resection may have grown and become visible during the follow-up [2]. Third, cancer cells may have become implanted in normal or resected areas of the epithelium during or after TURBT [3,4].…”

Molecular Evidence Supporting Field Effect in Urothelial Carcinogenesis

“…In addition, urothelial carcinoma cells in animal models have been shown to be capable of adhering to urothelium and subsequently growing into tumors, especially when the urothelium has been previously injured (48 -50). Tumor cells may be implanted in other urothelial sites secondary to cystoscopic manipulation (51,52). The fieldcancerization theory, which has been shown to be important in the development of multicentric squamous cell carcinomas of the head and neck (53 -55), suggests that multifocal urothelial carcinomas arise secondary to numerous independent mutational events at different sites within the urothelial tract as a consequence of external cancer-causing influences.…”

Efficacy of Postoperative Bladder Irrigation with Water for Injection in Reducing Recurrence Rates of Non Muscle Invasive Bladder Cancer

“…85% of patients will relapse, mainly during the first postoperative year (Heney et al, 1982;Dalesio et al, 1983;Torti et al, 1987;Gkritsios et al, 2013). Many recurrences are probably new tumors derived from urothelial dysplastic areas, but a significant proportion can be derived from tumour cells released during resection and eventually implanted in the injured areas (McDonald et al, 1956;Weldon et al, 1975;Page et al, 1978;Soloway et al, 1980;Hyacinthe et al, 1995;Selman et al, 2011).…”