Malignant Disease of the Urinary Bladder

Of 290 cases registered as cancer of the bladder at the Peter MacCallum Clinic, 28 were discarded as being wrongly registered or diagnosed, or unable to be assessed in any useful way. Two hundred and sixty-two cases were reviewed in detail. Symptomatology, sex and age distribution are in no way different from other published series. Attention is drawn to the influence of smoking in lowering the age of onset, this effect being more marked in women. The lack of concomitant lung cancer is felt to be worthy of comment when 12 patients had other malignancies. The prognosis in relation to sex does not differ, but young patients seem to fare twice as well as old ones. The importance of pre-treatment staging and assessment of the histology is emphasized and a set of guide lines as to management is set out. Survival rates for the overall series show a five-year figure of 4/40 (10%) for unstaged; 8/31 (23%) for T.O; 6/36 (16%) for T.l; 4/22 (18%) for T.2; 2/20 (10%) for T.3; and 2/76 (2–6%) for T.4. The determinate figures at five years for radically treated, assessable cases are T.O 7/15 (43%), T.l 6/16 (35%), T.2 4/12 (33%), T.3 2/5 (40%) and T.4 1/6 (17%). Figures suggest that early total cystectomy is indicated for uncontrollable well differentiated mucosal tumours, while radiation alone–or as an electivepreoperative measure–is preferable for poorly or moderately differentiated tumours. Pure squamous or adenocarcinomas are radio-resistant and seldom operable, but cystectomy is the only treatment likely to be curative. A tendency to squamoid or adenocarcinomatous differentiation, however, is not a sign that radiotherapy will fail. Radiation under hyperbaric oxygenation holds some promise for improving the local clearance of tumour. Cytology may be of some use in selecting follow-up cases for cystoscopy, but its accuracy requires some improvement.