The value of lymphography in the management of bladder cancer

The value of aspiration cytology in the definitive staging of bladder carcinoma

Aspiration cytology is a simple, accurate and minimally invasive procedure in staging urological neoplasms. Percutaneous fluoroscopy-guided fine needle aspiration biopsy of 99 lymph nodes was performed in 30 patients with bladder carcinoma and 62 lymph node chains were evaluated. Aspiration biopsy is more accurate and specific than lymphography in the pre-operative staging of the neoplasm and represents a useful diagnostic procedure for the staging of bladder carcinoma.

An analysis of the contribution of computed tomography to the treatment outcome in bladder cancer

The survival pattern of 60 patients is reported and clinical details given. It has been possible to show significantly poorer survival in those patients whose tumour was incompletely enclosed by the 90% isodose, and the reasons for this have been discussed. The demonstration of pelvic lymph node enlargement has also been shown to be an indicator of poor prognosis.

The current practice of lymphography: a survey in the age of computed tomography

A postal survey has revealed a reduction in the practice of lymphography in several hospitals where body computed tomography (CT) is available. Nowhere in this country has this reduction been quite so marked as in East Anglia, where very few lymphograms are now performed. Some of the factors which may be responsible are assessed; in particular, the introduction of body CT.

Postoperative radiation therapy for muscle-invading bladder carcinoma

From 1974-1980, 15 patients with pT2-4 bladder carcinoma received adjuvant postoperative radiation therapy (XRT). The extent of initial surgery varied (six radical cystectomy, 5 partial cystectomy, four "total" transurethral resection). The planned XRT was 4,000-5,040 rads in 5-6 weeks to the pelvis (achieved in 14/15 patients) followed by a bladder boost in noncystectomized patients (achieved in 8/9). Survival at two years and five years was 54% (7/13 patients) and 27% (3/11 patients), respectively. Local-regional disease control (minimum two-year follow-up) was achieved in 7/11 (63%). Of seven patients alive at least two years later, small bowel complications (chronic diarrhea, obstruction) occurred in two; these latter patients each had had radical cystectomy. Adjuvant postoperative XRT may be useful in the multimodality management of patients with bladder carcinoma, especially those identified as high risk after pathologic staging and initial surgery. The poor regional control rate and relatively high incidence of complications seen in this and previous studies suggest that improved radiation technique is needed, both to ensure adequate coverage of the volume at risk and to minimize complications. Representative portals are shown to illustrate these features.

Prognostic factors in local surgical treatment of invasive bladder cancer, with special reference to the presence of urothelial dysplasia

Thirty-three patients with bladder cancer of categories pT1 or pT2 were treated by transurethral resection alone. At the initial diagnosis random preselected site mucosal biopsies were obtained to demonstrate the presence or absence of concomitant urothelial dysplasia. A statistically significant (P less than 0.01) relationship was found between the presence or absence of concomitant urothelial dysplasia and the development of new occurrence or the absence of recurrence at cystoscopic follow-up. Four of six patients with concomitant carcinoma in situ developed invasive bladder cancer within 6 months demonstrating the serious prognostic significance of this entity. Thus, the presence or absence of concomitant urothelial dysplasia at the initial diagnosis of invasive bladder cancer seems to be an important prognostic factor for future new occurrences.

Lymphography in the evaluation of urinary bladder carcinoma

Lymphography was performed in 41 patients with bladder carcinoma. The lymphographic findings were correlated to the clinical and histological staging and the pre-operative grading. Twenty-seven patients were operated upon. The findings of lymphography were compared with the findings at operation, and the pathological examination of the removed lymph nodes. The lymphographic diagnosis was proved to be correct in 77.7% of the patients. There were two false positive lymphographies, and one false negative. Lymphography in groups T3 or T4 yielded a high diagnostic accuracy.

Bipedal lymphography in the management of bladder cancer

Bipedal lymphography was performed in 91 patients with transitional cell carcinoma of the bladder. Equivocal reports were submitted in 18 (19.8%) examinations. In this series 18 (19.8%) of the patients died within one year of first treatment by radical radiotherapy. The prognosis was poorer in patients with more locally advanced tumours, in whom there was a higher proportion of abnormal lymphograms. An abnormal lymphogram was also related to a poorer prognosis than if the lymphogram was normal. This difference was greater when associated with a poorly differentiated cancer. The implications for management are discussed.

Reliability of lymphography as a diagnostic aid in the planning of treatment for bladder carcinoma

To assess the accuracy of lymphography, 90 lymphograms were compared with surgical and histological findings. Histological correlation with the initial report was found in 65 to 90 cases (72%). Comparison of the original radiologist's report with a recent re-examination showed agreement between the two radiological evaluations in only 74%. Although improvement in diagnostic accuracy can perhaps be obtained, we cannot yet recommend lymphography as an aid in the planning of treatment for bladder carcinoma.

The pattern of spread and treatment of metastases in testicular seminoma

The results of treatment of 199 patients referred to the Royal Marsden Hospital with testiclar seminoma from 1963 to 1975 are described. Of 190 previously untreated patients 16 (8.4%) have died of seminoma, 3 (1.5%) of teratoma and 9 (4.9%) of intercurrent disease. Of 121 Stage I patients the only death was due to a second testicular tumour. In orchiectomy and volume of abdominal node metastases. This was not, however, prognostically significant. Death from seminoma occurred in 6 out of 38 patients (15.8%) with nodal metastases less than or equal to 5 cm in diameter and 3 out of 16 patients (18.7%) with metastases greater than 5 cm in diameter; 2 of 8 Stage III patients died of seminoma. Thus radiation controlled nodal metastases in more than 80% of Stage I, II and III patients. In Stage IV patients and patients referred with disease relapse, 12 out of 16 patients died of seminoma. Chemotherapy experience is briefly reviewed. Cyclophosphamide as a single agent has produced a 50% response rate. There is no evidence to suggest a radiation-related increase in mortality from the group of long-term tumour-free survivors.