Symptomatology

Abstract

In over 90% of cases of bladder cancer it is the symptoms that lead to the diagnosis and treatment; relatively few cases are detected incidentally or by routine screening methods. The period of time that a tumour is symptomatic is relatively short, compared with the total life span of the tumour, and the period when the tumour is symptomatic and curable (i.e. is localised) varies with the biological characteristics of the tumour. When breakthrough of the basement membrane occurs and the tumour becomes invasive, then the prognosis decreases sharply with each stage of invasion. This is clearly shown in the 3-year survival figures for each depth of infiltration (Table 4.1) reported by Pryor (1973). Assuming that both the depth of invasion and the development of metastases are functions of time, then every delay in instituting treatment may have a marked effect on the survival. Conversely, there may be little consequence in delaying treatment for a non-invasive papillary tumour, but the risks of leaving such tumours untreated have not, for obvious reasons, been established. Even so, there is clearly an appreciable risk of invasion and metastases, and therefore the low malignant potential of most papillary tumours cannot be used as an excuse for any lack of urgency in instituting treatment.