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Dual-track pathway of bladder carcinogenesis: practical implications.
Philippe E Spiess1, Bogdan Czerniak
1Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Archives of Pathology & Laboratory Medicine
|June 3, 2006
Summary
Bladder cancer develops via two pathways: papillary and nonpapillary. Both bladder cancer types originate from preneoplastic lesions, despite their differing characteristics and clinical behaviors.
Area of Science:
- Uro-oncology
- Cancer biology
- Pathology
Background:
- Bladder cancer arises from distinct papillary and nonpapillary pathways.
- Papillary tumors (80%) are low-grade, superficial, and rarely invasive.
- Nonpapillary tumors (15-20%) are high-grade, invasive, and prone to metastasis.
Purpose of the Study:
- Review the dual-track concept of bladder carcinogenesis.
- Summarize scientific literature on bladder cancer pathways.
- Discuss clinicopathologic implications of these pathways.
Main Methods:
- Literature review of PubMed-indexed articles.
- Search conducted between 1974 and 2005.
- Focus on bladder carcinogenesis pathways.
Main Results:
- Papillary and nonpapillary tumors exhibit significant clinicopathologic differences.
- Papillary tumors originate from urothelial hyperplasia.
- Nonpapillary tumors arise from high-grade intraurothelial neoplasia.
Conclusions:
- Both bladder cancer pathways initiate from occult clonal expansion of preneoplastic lesions.
- These lesions affect large areas of the bladder mucosa.
- Evidence supports a dual-track model of bladder carcinogenesis.