Mapping Cancerous and Precancerous Bladder Changes

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Abstract
Ten cancerous bladders were evaluated by histologic study of the totally embedded epithelium. Every patient had evidence of diffuse epithelial abnormalities, ranging from hyperplasia to nonpapillary carcinoma in situ, in areas adjacent to and remote from obvious tumors. One or both distal ureters showed carcinoma in situ in six cases and a papillary carcinoma grade 2 in another. The urethra was involved in five cases, with one instance of carcinoma in situ observed one year after cystectomy. An aggressive evaluation of the entire bladder epithelium by cytologic study of urinary sediment and multiple biopsies is essential for a rational approach to treating bladder cancer. In patients with evidence of diffuse epithelial abnormalities, an early cystectomy may be contemplated in order to improve the dismal statistics of survival in patients with high-stage tumors.