The pathologist's role in multidisciplinary management of bladder cancer

The pathologist plays an important role in management of bladder cancer, as a member of the multidisciplinary team of urologists, radiation therapists, and medical oncologists. The therapeutic goal is saving the bladder function as long as possible. The pathologic determinants utilized for selection of therapeutic modalities are described in 172 consecutively treated patients with transitional cell carcinoma and 20 patients with other forms of bladder tumors during a five year period. Based on histologic type, pathologic stage, and status of the urothelium, 100 patients were treated by resection and intravesical instillation of cytostatic drugs or bacille Calmette-Guérvin (BCG). Seventy patients underwent radical cystectomy and bladder substitution by continent urinary diversion. Serial transurethral resection (TUR) biopsies and cytologic evaluations were found adequate in evaluating pathologic determinants for progression and for survival except in cases of Grade 2 papillary transitional carcinomas where additional experimental studies need to be further developed, such as nuclear ploidy and molecular genetic studies, to identify patients at high risk for progression. Of the 70 patients with radical cystectomy and 5 with partial cystectomy, 49 are living, a median of 36.8 months since surgery. There was one intraoperative death and one post-operative death within 30 days post-operatively.