M.K. Gospodarowicz

Colon and Rectum

Carcinoma of the large intestine has undergone relatively few basic modifications between the 6th and 7th TNM editions so that the main T, N, and M categories and Stages I, II, III, and IV can be compared with those of the previous two editions. A number of subdivisions of these major categories have been made. Despite this expansion, all of the substages can be collapsed back into the original four stages of previous TNM classifications covering a 30 year span as well as being compatible with the original Dukes classification, thus ensuring backwards compatibility.

Urinary Bladder Carcinoma

Urinary bladder carcinoma is a heterogenous disease with considerable variation in its natural history. The 5-year survival rate varies from 90% for patients with superficial, well-differentiated tumors to 0%–10% for those with locally extensive tumor invading the pelvic side wall. Many clinical and pathologic factors including stage, grade, tumor size, multiplicity, tumor growth pattern, vascular invasion, positive urine cytology, or coexistent carcinoma in situ (Tis) have been described to affect the outcome. There is, however, a relative paucity of information regarding the more fundamental immunologic, biochemical, and molecular factors which may be of considerable prognostic importance. Prognostic factors may be related to the tumor itself, the patient, and the treatment delivered. This discussion will focus mainly on disease-related factors. Treatment-related factors, such as the method and quality of treatment, will not be discussed in detail, as there is a paucity of reliable comparative data as to the impact of therapy on outcome. Relatively few studies of prognostic factors in bladder carcinoma incorporate comprehensive multivariate analysis - thus the references quoted below also include studies which demonstrate compelling evidence for certain factors by univariate analysis only.