Intravesical BCG therapy appears to be ineffective against micropapillary UC. Our results suggest that the optimal treatment strategy for nonmuscle invasive micropapillary UC is radical cystectomy performed before progression.

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BACKGROUND Micropapillary bladder carcinoma is a rare variant of urothelial carcinoma. To improve understanding of this disease, the authors performed a retrospective review of their experience. METHODS The authors reviewed the records of 100 consecutive patients with micropapillary bladder cancer who were evaluated at The University of Texas M. D. Anderson Cancer Center. RESULTS The mean age of the patients was 64.7 years, with a male:female ratio of 10:1. The TNM stage of disease at the time of presentation was Ta in 5 patients, carcinoma in situ (CIS) in 4 patients, T1 in 35 patients, T2 in 26 patients, T3 in 7 patients, T4 in 6 patients; N+ in 9 patients, and M+ in 8 patients. Kaplan‒Meier estimates of 5‒year and 10‒year overall survival (OS) rates were 51% and 24%, respectively. Bladder‒sparing therapy with intravesical bacillus Calmette–Guerin therapy was attempted in 27 of 44 patients with nonmuscle‒invasive disease; 67% (18 patients) developed disease progression (≥cT2), including 22% who developed metastatic disease. Of 55 patients undergoing radical cystectomy for surgically resectable disease (≤cT4a), 23 received neoadjuvant chemotherapy and 32 were treated with initial cystectomy, with no significant difference noted in stage distribution between the 2 groups. For the 23 patients treated with neoadjuvant chemotherapy, the median OS was 43.2 months with 32% of patients still alive at 5 years. For the 32 patients treated with initial cystectomy, the median survival had not been reached at the time of last follow‒up, with 71% still alive at 5 years. CONCLUSIONS Micropapillary bladder cancer is associated with a poor prognosis. Intravesical therapy appears to be ineffective in this disease and patients with surgically resectable disease should be offered early radical cystectomy. Cancer 2007. © 2007 American Cancer Society.

A discussion of dominant discourses across race, gender, and other identities is provided, especially in terms of consequences. Distinctions are made between consequences of social constructions and identity. An example of a counselor working with a client is provided to illustrate several points made by the author.

This study examines skin color in the lives of African American adolescents and explores the relationship to self-esteem and dating relationships. Adolescents between the ages of 11 and 19 years were recruited through schools, churches, and informal networks. A questionnaire was developed by the researchers to explore the meaning of skin color in the lives of African American adolescents and its effect on self-esteem. Primary studyfindings were that (a) a relationship existed between satisfaction with skin color and self-esteem; (b) students self-reported as "lighter" or "darker" had lower levels of satisfaction with their skin color than did students whose skin color was classified as "somewhere in between"; (c) although the difference was nonsignificant, a greater proportion of men than women expresseda desirefor lighterskin; and (d) a gender difference was noted on the dating variable, "Skin color makes a difference to guys when they date girls." Implications of thefindings are discussed.