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Natural History and Patterns of Invasive Cancer of the Bladder

Introduction epithelial abnormality described by Melicow and Holloway [2] could occur not only as a disorder accompanying clinically obvious tumors, but also as a primary event One of the most disturbing aspects of oncologic urology is the erroneous concept that any tumor of the bladder in the urinary bladder. The significant contribution on this topic was a series of papers from my laboratory, is capable of progression to invasive carcinoma. The concept can be traced back to a paper by Jewett and Strong describing a group of industrial workers exposed to a potent bladder carcinogen, paraaminodiphenyl, in whom [1] in 1946. The paper was based on an analysis of 100 autopsies on patients with bladder cancer and docucytologic study of the urinary sediment disclosed cancer cells in the absence of visible bladder lesions. After a delay mented that tumors confined to the epithelium or, at most, extending to the lamina propria of the bladder, of 4–12 years over one half of these workers developed invasive cancer of the urinary bladder [3]. Evidence from produced no metastases. The frequency of metastases was shown to be clearly related to the depth of invasion. This several studies of primary invasive carcinoma of the bladder also indicated that in most of these patients there was study and its variants, led to the adoption of the original classification system of bladder tumors that for many no evidence of a prior papillary tumor [4, 5]. It is evident therefore that most invasive cancers of the bladder are years guided urologists in planning treatment and assessing the prognosis of bladder cancer. The classification derived from invisible, i.e. flat, lesions known as carcinoma in situ and related poorly defined epithelial abnorsystem did not differentiate among the various types of primary events leading to invasive bladder cancer and malities classified as ‘dysplasia’. Because ‘dysplasia’ is a precursor lesion of invasive cancer, I proposed that the assumed that all precursor lesions were papillary. Unnoticed for many years was the 1952 contribution term ‘intraurothelial neoplasia’, divided into 3 grades, be adapted to define the precancerous flat intraepithelial by Melicow and Holloway [2] describing carcinoma in situ or Bowen’s disease of the urinary bladder, a malignant lesions of the urothelium [6]. There is, of course, a group of patients who develop transformation of the epithelium of the urinary bladder, observed in grossly normal epithelial segments adjacent invasive bladder cancer following treatment for, or in the presence of, a papillary tumor. Mapping studies of the to visible tumors. bladder have shown that in most such cases the invasive tumors were derived from synchronous coexisting foci of carcinoma in situ or dysplasia [7]. Less commonly highOrigins of Invasive Carcinoma grade papillary tumors, which are usually accompanied by carcinoma in situ and related lesions, may progress It was only with the onset of cytologic examination of the urinary sediment that it became evident that the directly to invasive cancer [8].