Abstract
Recent interest in intravesical instillation of bacillus Calmette-Guérin for the management of carcinoma in situ (CIS) of the bladder prompted us to review our results of total immediate cystourethrectomy. From 1975 to 1987, we surgically treated 302 patients with primary bladder tumours. Of these, 21 bladder tumours were histologically diagnosed as CIS, and total immediate cystourethrectomy was performed in all cases. The lesions were classified into three types: primary CIS accompanied by neither previous nor simultaneous tumours of the urinary tract (Type 1,9 patients), concomitant CIS associated with superficial papillary tumour (Type 2, 6 patients), and secondary CIS detected during the follow-up period after treatment of the superficial papillary tumour (Type 3, 6 patients). Primary CIS was more often diagnosed according to subjective symptoms such as micturition patin than concomitant CIS. Secondary CIS was diagnosed in all patients by routine examinations including cytology and cystoscopy. There was no particular relationship between the time of recurence of the tumour and the occurrence of secondary CIS. Within the same period, 60 patients with stage T1 bladder tumour were treated by total cystourethrectomy. The actuarial 5-year survival rate was 77% for T1 and 75% for CIS. The 5-year survival rate was 71% for Type 1, 83% for Type 2, and 67% for Type 3 CIS with no difference among the CIS types.
Tumour invasion to the bladder, prostate, ureter, or lymph nodes was observed in 9 (42.9%) of the 21 patients, although cystourethrectomy was performed within 3 months of the diagnosis. Examination of ABH antigens did not allow prediction of invasion of CIS.
Our findings suggest that the invasive potential of CIS may seriously limit the indications of conservative treatment against carcinoma in situ.
Similar content being viewed by others
References
Soloway, M. S.: The management of superficial bladder cancer.Cancer, 45, 1856 (1980).
Kakizoe, T., Tobisu, K., Takai, K.: Relationship between papillary and nodular transitional cell carcinoma in the human urinary bladder.Cancer Res., 48, 2299 (1988).
Tsujihashi, H., Matsuda, H., Uejima, S., Kurita, T.: Cell proliferation of human bladder tumors.J. Urol., 142, 1113 (1989).
Tsujihashi, H., Matsuda, H., Uejima, S., Kurita, T.: The kinetics of cellular proliferation in rat urinary bladder treated with N-butyl-N-(4-hydroxybutyl) nitrosamine.J. Urol., 144, 1493 (1990).
Morales, A., Eidinger, D., Bruce, A. W.: Intracavitary bacillus Calmette-Guérin immunotherapy of superficial bladder canceer.J. Urol., 116, 180 (1976).
Fujita, K.: The role of adjunctive immunotherapy in superficial bladder cancer.Cancer, 59, 2027 (1987).
Tsujihashi, H., Matsuda, H., Uejima, S., Kurita, T.: Immunocompetence of tissue infiltrating lymphocytes in bladder tumors.J. Urol., 140, 890 (1988).
Farrow, G. M., Utz, D. C., Rile, C. C.: Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy.Cancer Res., 36, 2495 (1976).
Farrow, G. M., Utz, D. C., Greene, L. F.: Clinical observations on sixty-nine cases of in situ carcinoma of the urinary bladder.Cancer Res., 37, 2794 (1977).
Prout, G. R., Griffin, P. P., Heney, N. M.: Carcinoma in situ of the urinary bladder with and without associated vesical neoplasms.Cancer, 52, 524 (1983).
Fukui, I., Yokokawa, M., Oshima, H.: Carcinoma in situ of the urinary bladder. Effect of associated neoplastic lesions on clinical course and treatment.Cancer, 59, 164 (1987).
Brosman, S. A.: The use of bacillus Calmette-Guérin in the therapy of bladder carcinoma in situ.J. Urol., 134, 36 (1985).
Herr, H. W., Pinsky, C. M., Melamed, M. R.: Long-term effect of intravesical bacillus Calmette-Guérin on flat carcinoma in situ of bladder.J. Urol. 135, 265 (1986).
Stanisic, T. H., Donovan, J. M., Graham, A. R.: 5-year experience with intravesical therapy of carcinoma in situ. An inquiry into the risks of “conservative” management.J. Urol., 138 1158 (1987).
Prout, G. R., Griffin, P. P., Daly, J. J.: The outcome of conservative treatment of carcinoma in situ of the bladder.J. Urol., 138, 766 (1987).
Koss, L. G.: Tumors of the Urinary Bladder. Atlas of Tumor Pathology, 2nd ser., fasc. 11 (Armed Forces Institute of Pathology, Washington 1975).
Union Internationale Contre le Cancer: TNM classification of malignant tumors (Union Internationale Contre le Cancer, Geneva 1974).
Kakizoe, T., Matsumoto, K., Kishi, K.: Treatment of carcinoma in situ by total cystectomy. Histopathological analysis. tWorld J. Urol.,1, 106 (1983).
Tsujihashi, H., Akiyama, T., Kurita, T.: Detection of ABH antigens via exfoliated urinary cells. A preliminary report.Urol. Int., 42, 431 (1987).
Kaplan, E. L., Meier, P.: Nonparametric estimation from incomplete observations.J. Am. Stat. Assoc., 53, 457 (1958).
Kaye, K. W., Lange, P. H.: Mode of presentation of invasive bladder cancer. Reassessment of the problem.J. Urol., 128, 31 (1982).
Ohtani, M., Kakizoe, T., Niijima, T.: Sequential changes of mouse bladder epithelium during induction of invasive carcinomas by N-butyl-N-(4-hydroxybutyl)nitrosamine.Cancer Res., 46, 2001 (1986).
Utz, D. C., Hanash, K. A., Farrow, G. M.: The plight of the patient with carcinoma in situ of the bladder.J. Urol., 123, 160 (1970).
Althausen, A. F., Prout, G. R., Daly, J. J.: Non-invasive papilary carcinoma of the bladder associated with carcinoma in situ.J. Urol., 116, 575 (1976).
Winstein, R. S., Miller, A. W., Pauri, B. U.: Carcinoma in situ. Comments on the pathobiology of a paradox.Urol. Clin. North Am., 7, 523 (1980).
Haaf, E. O., Ratliff, T. L., Catalona, W. J.: Two courses of intravesical bacillus Calmette-Guérin for transitional cell carcinoma of the bladder.J. Urol., 136, 820 (1986).
Emmott, R. C., Droller, M. J., Javadpour, N.: Studies of A, B or O(H) surface antigen specificity. Carcinoma in situ and non-malignant lesions of the bladder.J. Urol.,125, (1981).
Herr, H. W., Whitmore, W. F., Pinsky, C. W.: Extravesical Carcinoma in situ after Intravesical Bacillus Calmette-Guérin (BCG). Read at Annual Meeting of American Urological Associations. Las Vegas, Nevada, April 17–21, 1983. Abstract 346, p. 178.
Herr, H. W., Whitmore, W. F.: Ureteral carcinoma in situ after successful intravesical therapy for superfical bladder tumors. Incidence, possible pathogenesis and management.J. Urol., 138, 292 (1987).
Schellhammer, P. E., Bean, M. A., Whitmore, W. F.: Prostatic involvement by transitional cell carcinoma. Pathogenesis, patterns and prognosis.J. Urol., 118, 399 (1977).
Hardeman, S. W., Perry, A., Soloway, M. S.: Transitional cell carcinoma of the prostate following intravesical therapy for transitional cell carcinoma of the bladder.J. Urol., 140, 289 (1988).
Wood, D. P., Montie, J. E., Levin, H. S.: Transitional cell carcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer.J. Urol., 141, 346 (1989).
Droller, M. J., Walsh, P. C.: Intravesical chemotherapy in the treatment of flat carcinoma in situ. Is it safe?J. Urol., 134, 1115 (1985).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tsujihashi, H., Nakanishi, A., Matsuda, H. et al. Clinical assessment of carcinoma in situ of the human urinary bladder. International Urology and Nephrology 24, 243–254 (1992). https://doi.org/10.1007/BF02549532
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02549532