Malachi J. Flanagan

Superficial Bladder Cancer: Progression and Recurrence

The tumors in 249 patients presenting initially with stages Ta and T1 bladder cancer were analyzed for tumor progression and recurrence. Only transurethral resection and/or fulguration was used before the first recurrence. Patients who received intravesical chemotherapy after the first tumor recurrence were excluded from an analysis of progression. Progression according to stages Ta and T1, and grades I, II and III was 4, 30, 2, 11 and 45 per cent, respectively. All differences were statistically significant. Progression also correlated with nontumor dysplasia and size. High tumor grade, lamina propria invasion, atypia elsewhere in the bladder, positive urinary cytology, tumor multiplicity and large tumors were associated with shorter intervals free of disease.

Long-term Fate of 90 Patients with Superficial Bladder Cancer Randomly Assigned to Receive or not to Receive Thiotepa

We assigned randomly 90 patients treated previously for superficial transitional cell carcinoma to conventional followup or prophylactic treatment. This followup study details the late incidence of recurrence (29 of 45 patients in the prophylactic group and 34 of 45 controls), the progression of tumor grade and stage, the deaths and causes (24 patients), and the influence of initial stage, grade, carcinoma in situ and positive cytology on the outcome of treatment.

Mitomycin C intravesical therapy in noninvasive bladder cancer after failure on thiotepa.

Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer. All patients had failed treatment with intravesical thiotepa and had evaluable disease. An objective response of 50% or greater reduction in measured tumor mucosal involvement was obtained in 68% of patients. Forty‐two percent of the patients achieved a complete response, and this included 50% of patients with Grade III disease and 70% of patients with a Tl tumor. Median response duration in complete responders was 12.2 months with a range of 3.5 to 24.3+ months. Fifty‐five percent of patients are still responding. Therapy was generally well tolerated, and in contrast to thiotepa, myelosuppression was not the dose‐limiting effect. One third of all patients experienced symptoms of local irritation, and skin reactions were seen in 12% of patients. Cancer 53:1025‐1028, 1984.

Isoantigens A, B and H in urinary bladder carcinomas following radiotherapy

ABH tissue isoantigens were measured by the Specific Red Cell Adherence (SRCA) test in 66 surgical specimens of urinary bladder, including 53 transitional cell carcinomas, 2 squamous cell carcinomas and 11 controls. The SRCA test was strongly positive in 10 of 11 controls. ABH isoantigens were absent or equivocally present in 68 percent of noninvasive carcinomas (stage 0) and in 65 percent of invasive carcinomas. Clinical histories revealed that all patients with invasive carcinoma who had strongly positive SRCA test results had received prior radiotherapy to the bladder region. None of the patients with invasive bladder carcinoma with negative or weakly positive SRCA tests had been radiated. Histopathology of tumors in both groups was similar. Results of this retrospective study support the hypothesis that radiation may induce differentiation in tumors, possibly through an enhancement of Golgi apparatus function. The SRCA test should not be used as a predictor of the biological behavior of future recurrences in patients with bladder carcinoma who have received therapeutic radiation since radiation may produce “false positive” SRCA test results.

Renal Medullary Carcinoma in Patients with Sickle Cell Trait

Renal medullary carcinoma has recently been described as an aggressive neoplasm affecting young African Americans with sickle cell disease or sickle cell trait. We report the presentation, treatment, and outcome in 3 patients with renal medullary carcinoma along with a description of the unsuccessful treatment attempts. A brief discussion and review of the literature is included.

Evaluation of Bladder Washing Cytology for Bladder Cancer Surveillance

Urinary cytology is almost as accurate as cystoscopy in appraising the presence or absence of visible tumor. Falsely negative results are virtually limited to low stage, low grade tumors. Urinary cytology often provides information about the neoplastic state of the epithelium not provided by cystoscopic examination. Cytology has become practical and simple to do even as an office procedure. Urinary cytology must be considered an essential part of patient management in bladder cancer surveillance.

Suprapubic cystostomy A simplified technique

A simple technique for performing a suprapubic cystostomy is presented. The only necessity is a modified male urethral sound.

Responsiveness of lymphocytes to soluble extracts of prostatic tumors and abrogation by serum-blocking factor(s)

Preliminary evidence is presented suggestive of antitumor immunity, cross reactive with allogeneic extracts from tumors of the same type, and serum-blocking factor(s), which appear to be specific to autologous tumor only, in patients with prostatic cancer employing the method of leukocyte adherence inhibition.