Reflections on bladder neoplasia. Exophytic papillary urothelial tumors versus planophytic carcinoma in situ

Exophytic (papillary) urotheliomas often occur concomitantly or sequentially with the planophytic carcinomas in situ. The natural history of the two types differs: the former initially shows cell uniformity, orderly arrangement of cell layers, and an adequate vascular supply whose branchings penetrate centrally into the fronds. They tend to respond favorably to any of the present-day modalities of treatment (excision, fulguration, thiotepa, etc). The exophytic urotheliomas are apparently stimulated by the host's normal urine: diversion of the latter is usually followed by disappearance of the tumors. The planophytic carcinomas in situ from incipiency show cell disorganization, hyperchromasia, a paucity of vascularity resulting in ulceration, invasion, nodularity, and endophytic spread. Response to the usual modalities of therapy is unpredictable and often disappointing. These reflections warrant reappraisal of our management and treatment, particularly in light of possible damage to the normal urothelium and the carcinogenic potential of the various agents presently employed. Since we do not at present have a specific cure for cancer of the bladder that has invaded and spread, it behooves us to avoid further injury and instead to maintain the integrity of the normal cells and retard the spread of the malignant ones. Vitamin C administered orally strengthens collagen that binds cells together and counteracts hyaluronidase - a product of the cancer cells - which loosens cells and accelerates their spread. Vitamin C is non-toxic and non-carcinogenic.