Analysis by step sectioning of early invasive bladder cancer with special reference to G3.pT1 disease

Eighty cases of cystectomized and step-sectioned pT1 transitional cell carcinomas of various grades were analyzed. During the same period, 30 consecutive cases of pT2 carcinomas were also cystectomized and examined for comparison. This is a cross-sectional study of a variety of cases of bladder cancer, designed to delineate the characteristics of G3.pT1 disease. Tumors in this series had a full set of various pathological findings; grades 1 to 3, stages Ta-T1-T2, papillary-papillonodular-nodular tumor configuration, alpha-beta-gamma type of invasion, presence of lymphatic and venous involvement, and presence of associated carcinoma in situ/dysplasia. There is a distinct tendency of stepwise disease progression, such as grade 1-->3, stage T1-->T2, papillary-->nodular configuration, and alpha-->gamma invasion, these factors being mutually related. We noted a similarity between tumor groups containing G3 component, such as G2-3.pT1, G3 > 2.pT1, G3.pT1, G1-3.pT2, and G3.pT2. These tumors are different from groups such as G1-2.pT1, G2.pT1 and G2 > 3.pT1 in terms of tumor configuration and type of invasion. As regards pT1 having G3 components, early cystectomy seems to be the surest treatment. Whenever one adopts a conservative policy in treatment of these tumors, extreme care should be taken to monitor tumor progression.