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.

The role of urine in a patient with a bladder neoplasm.

A review was done on reported cases of spontaneous regression of superficial bladder tumors in which cystectomy was preceded by bilateral ureterosigmoidostomy (the interval ranging from 21 days to 6 months). In every case in which the tumors were superficial complete disappearance of the papillary masses was observed by the naked eye and by microscopic examination. Tumor cells persisted in those cases in which the bladder wall was involved. I propose that the urine of the patient acts as a promoter to hyperplasia and neoplasia on foci of defective urothelial cells whose special coding apparatuses had been injured or destroyed by a carcinogen. The latter need no longer be present nor need there be exposure to co-carcinogen(s), such as is associated with excess alcohol intake or cigarette smoke inhalation. Tumor cells that were found in the excised bladder wall were cells that had become invasive (cancerous) and were no longer dependent.

The urothelium: a battleground for oncogenesis.

A discussion of the term urothelium and reasons for its general adoption are presented. The unique asymmetric unit membrane of the superficial cells is described and its function as a significant barrier against water, some electrolytes and so forth is reviewed. The urothelium bears the brunt of the attack by pollutants and various oncogens. The ongoing battle may be of long duration or recurrent. Many factors enter into the development of a tumor. In addition to actual carcinogens there are irritants, promoters, initiators, weak carcinogens and co-carcinogens. The attack is on the asymmetric unit membrane and the Golgi complex or other coding units. The specialized membrane is destroyed and, instead, a thinner, smooth, flexible membrane develops and overlying it a filamentous glycocalix. The mechanism for specialization by the urothelial cell has been destroyed by the oncogen. Cancer does not occur in unicellular organisms. The cells of all multicellular organisms specialize. The first step toward neoplasia in multicellular organisms is the destruction of specialized mechanisms or coding units of a group of specialized cells, the second step is stimulation by governors and the third is inadequate blood supply. The ultimate in the cancer cell of a multicellular organism, anaplasia, is the return to the unicellular stage.

Pathology and natural history of urethral tumors in females: review of 65 cases.

Cancer of the female urethra, although uncommon, is important because unless recognized early and treated adequately, death will ensue, preceded by much morbidity. The authors present a series of 62 patients with 70 primary tumors, and 3 patients with secondary tumors. A comprehensive classification of neoplasms of the female urethra is also included.

A spectrum of malignant epithelial tumors of the prostate gland.

Conceptually, the prostatic territory encompasses neoplams whose origins are intraprostatic, paraprostatic or extraprostatic. Our objectives in this review are to 1) present a classification of the spectrum of malignant epithelial growth encountered in the prostatic territory, 2) show examples of these neoplasms and remark upon their histogenesis, enzyme production and endocrine sensitivity, and 3) suggest re-evaluation of some of our current routine therapeutic procedures.

Double primary prostatic adenocarcinoma.

Two cases of double primary prostatic adenocarcinoma are described. A periurethral papillary adenocarcinoma coexisted with the common acinar type of cancer, which tends to arise deep in the corpus of the gland. We are of the opinion that the patterns observed in these tumors are not mere variations of one neoplasm, but rather two dissimilar growths of diverse cell origin, varried histology, and possibly also of disparate biologic potential.