Urinary bladder cancer. Selecting initial therapy.

Selection of optimal primary therapy for bladder cancer patients requires a multidisciplinary approach based on an evaluation of the location, extent and, if possible, the virulence of the tumor(s), and the host response. Currently, cystoscopic observation and morphologic assessment of cellular and tissue specimens are the main sources of information. The urologist and pathologist are chiefly responsible for collecting this information, but other laboratory approaches also are being developed. The urologist must prepare a "seen at cystoscopy" diagram of the bladder mucosal surface and indicate in both the diagram and the cystoscopy report the number, location and appearance of tumors and other abnormalities. The cytopathologist must be as precise as possible in defining abnormalities in cellular preparations, and the histopathologist must not only indicate the microscopic diagnosis but the presence or absence of muscle in each biopsy specimen.