Cancer of the Urinary Bladder

Cancer of the bladder is not one of neoplastic disease, but a group of various cancers of different histologic patterns with different natural histories and pathologic behaviors. As a consequence of the above, different forms of treatment become necessary, depending upon different individual circumstances. Apart from the biologic behavior tendencies of cancer of the bladder, another unique characteristic is that the bladder serves the essential function of storage of urine so that if it becomes necessary to sacrifice the bladder by surgery, provision for urinary storage must be made. To date all such provisions are makeshifts.

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Furthermore, cancer of the bladder, apart from threatening the patient's health and existence by local extension and distant metastases, is potentially lethal through secondary effect of damaging kidney function by ureteral obstruction with concomitant infection. And finally, not only recurrences of the original tumor, but the occurence of other tumors from oci, represent another undesirable characteristic.

For many years bladder tumors have been classified on the basis of their cystoscopic appearance. There are the multiple, small, benign papillary type of tumor which should be regarded as a Grade I carcinoma, for eventually these tumors may become invasive. Next there is the second type of tumor with a broad base and cauliflower-like appearance which is a malignant papilloma and usually infiltrating. Then there is the third type, an ulcerative lesion, which is quite frequently a squamous cell carcinoma.

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Recently it has been suggested that all bladder tumors should be classified, not upon their appearance under the microscope, but rather upon the extent of their invasion through the wall of the bladder:

1.Those growing superficially on the bladder mucosa.

2.those that have become invasive and the invasion has been limited to the tunica propria.

3.those that have invaded into the muscular wall of the bladder.

4.those that have invaded all the way through the wall of the bladder and finally,

5.those with metastatic growth outside the bladder.

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