Department of Urology and Clinical Genetics, Assafa Academy, SudanFulltext PDF
Bladder cancer is a common disease, worldwide it is ranked as the seventh and the seventeenth most frequent cancer worldwide in men and women respectively. Based on the histopathology (grading and staging), bladder cancer can be classified into non-muscle invasive (superficial) and muscleinvasive disease. The natural history of the superficial tumors differs from the muscle invasive ones. Most non-muscle invasive tumors are characterized by multiplicity, high recurrence rate, and heterogeneous natural history. According to many investigators, the multifocal nature of nonmuscle invasive uroepithelial cancer, together with a propensity for recurrence (polychrono topicity) is the results of intraluminal seeding of viable detached malignant cells that results in genetically monoclonal multiple tumors. Thus, the intraluminal shedding and implantation of viable tumor cells have been proposed as the mechanisms responsible for both synchronous and metachronous multifocal bladder tumors. These findings are of considerable relevance for therapeutic strategies, suggesting that complete endoscopic removal of the primary tumor is often not enough to treat even non-muscle invasive bladder cancer because by, or during, the time of initial treatment, several micro satellite tumors are already implanted in the bladder. Therefore, additional measures to prevent tumor cell seeding and growth of the already implanted ones may reduce the recurrence rate of non-muscle invasive bladder cancer.The intraluminal seeding mechanism of synchronous and/or metachronous tumors enforces more emphasis on intravesical adjuvant therapy in superficial bladder cancer, including the use of intravesical chemo- or immunotherapy and long interval follow-up for those patients. Adopting such therapeutic strategy may improve morbidity and mortality of superficial bladder cancer.
Fadl-Elmula I. The Impact of Monoclonal Origin and Intraluminal Seeding Mechanism on Management of Non-Muscle Invasive Bladder Cancer: Needs for More Preoperative Adjuvant Intravesical Immune-and/or Chemo- Therapy. Clin Oncol. 2018; 3: 1420.