1980 Volume 71 Issue 8 Pages 829-839
Ninety cases of urinary bladder cancer treated by radical cystectomy with pelvic nodes dissection were reviewed.
The five year survival rate of the transitional cell carcinoma cases of in low and high stage was 80.6% and 39.7% respectively. Urethral recurrence following cystectomy was observed in 7.4%. Sixty-four cases had no lymph node involvement, and the five years survival rate of these cases was 92.9%. In twenty-six cases, more than one lymph node involvement was disclosed and the five years survival rate of these cases was only 26.8%.
Fifty-eight specimens of the bladder were examined by step section of the entire urothelium. The distribution of carcinoma, carcinoma in situ and atypism was schematically illustrated. According to the analysis of schema and tumor growth pattern, bladder cancer could be divided into the following four types: Type 1 is unifocal papillary cancer without invasion. Slight atypism is observed in the vicinity of the neoplasm. Type 2 is multifocal papillary cancer without invasion. Atypism is observed even in the area far from the overt neoplasm. Type 3 is multifocal invasive carcinoma. Multifocal carcinoma in situ is also observed in the area far from the overt neoplasm. Type 4 is unifocal invasive carcinoma. Any preneoplastic change in other mucous membrane is not observed. This type of carcinoma shows a rapid growth and special malignancy.
According to the retrospective analysis of the clinical course of each type, a plan for reasonable treatment of bladder cancer may be proposed as follows.
The 1: This type may be controlled sufficiently by TUR or partial cystectomy when the tumor is in the low stage. When the stage is beyond B, total cystectomy is recommended.
Type 2: This type may be basically controlled by TUR, but the recurrence is observed frequently. Careful follow up of the patients is mandatory and when the stage appears B, total cystectomy is indicated.
Type 3: This type should be treated by total cystectomy including urethrectomy and lymph nodes dissection.
Type 4: In this case total cystectomy and lymph nodes dissection must be performed immediately.
