[The progress pattern of carcinoma in situ of the urinary bladder]

Forty patients with carcinoma in situ of the bladder were reviewed. They included 15 patients with primary carcinoma in situ, 8 with secondary carcinoma in situ and 17 with concurrent carcinoma in situ. Twenty-one (66%) of 32 patients with primary or concurrent carcinoma in situ complained of urinary frequency and pain on urination, whereas no patients with secondary carcinoma in situ complained of such symptoms. Nearly all patients with concurrent or secondary carcinoma in situ had gross hematuria, whereas only 7 (47%) of 15 patients with primary carcinoma in situ had gross hematuria. Two patients without any symptoms were diagnosed by incidental positive urinary cytology. Concurrent carcinoma in situ was always associated with multiple papillary tumor. Dominant grade of the papillary tumor was classified as grade 3 in 11 patients and as grade 2 in 6. The simultaneous presence of carcinoma in situ of the urethra was found in 13 (46%) patients and those of the ureter in 17 (74%). Fourteen patients (35%) with carcinoma in situ developed an invasive carcinoma. Of these, 4 (10%) died of cancer. Bacillus calmette-guerin instillation was effective in 13 of 15 patients (87%). These results indicate that carcinoma in situ of the bladder may develop an invasive cancer, may remain in the epithelia, or may be associated with multiple superficial tumor. It should be emphasized that patients with multiple superficial bladder tumor may be associated with carcinoma in situ even if the superficial tumors are of low grade and urine cytology is negative.