It is well recognized that the actual onset of malignant change may antedate by a considerable time the first identifiable morphologic manifestations of neoplasm and that the latter in turn may precede the first symptomatic manifestations of the process. Even after the appearance of symptoms, the interval before the specific diagnosis is accurately made may be long—a possibility for which the site and nature of the malignant change, the patient, and the physician share varying degrees of responsibility. Furthermore, the presence of a clinically obvious neoplasm at one site in a tissue or organ is often associated with an increased probability of coexistent neoplastic change at other sites in the respective organ or tissue.
These generalizations relative to tumor behavior have specific application in the case of neoplasms of the human bladder. The possibility that cancer of the bladder may have a preclinical phase has been overshadowed by the facts
Whitmore WF, Bush IM. Ultraviolet Cystoscopy. JAMA. 1968;203(12):1057–1059. doi:10.1001/jama.1968.03140120055013
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