THE PATHOLOGISTS ROLE IN MULTIDISCIPLINARY MANAGEMENT OF BLADDER-CANCER

The pathologist plays an important role in management of bladder cance r, as a member of the multidisciplinary team of urologists, radiation therapists, and medical oncologists. The therapeutic goal is saving th e bladder function as long as possible. The pathologic determinants ut ilized for selection of therapeutic modalities are described in 172 co nsecutively treated patients with transitional cell carcinoma and 20 p atients with other forms of bladder tumors during a five year period. Based on histologic type, pathologic stage, and status of the urotheli um, 100 patients were treated by resection and intravesical instillati on of cytostatic drugs or bacille Calmette-Guervin (BCG). Seventy pati ents underwent radical cystectomy and bladder substitution by continen t urinary diversion. Serial transurethral resection (TUR) biopsies and cytologic evaluations were found adequate in evaluating pathologic de terminants for progression and for survival except in cases of Grade 2 papillary transitional carcinomas where additional experimental studi es need to be further developed, such as nuclear ploidy and molecular genetic studies, to identify patients at high risk for progression. Of the 70 patients with radical cystectomy and 5 with partial cystectomy , 49 are living, a median of 36.8 months since surgery. There was one intraoperative death and one post-operative death within 30 days post- operatively.