Bladder Biopsy Questions

[Sick_in_YYC]

Hi- I received the biopsy from my TURBT earlier this month. Three tumours were removed and approximately 1/3 of bladder resected. Summary is below:

Summary:

– high grade papillary urothelial carcinoma, non-invasive;

– negative for carcinoma in-situ; and

– unremarkable muscularis propria abundantly sampled.

I have some questions so I can understand the report and prepare for my meeting with my urologist:

1) Is this considered Ta or T1?;

2) What is meant by “unremarkable muscularis propria abundantly sampled” mean?; and

3) What are the likely treatment options I will be offered?

I meet with my urologist at the end of the month. Thanks in advance.

[marysue]

Hi Sick_in_YYC:

The type of bladder cancer that you have is the most common kind.  Urothelial carcinoma is the type of bladder cancer that most often visually looks like pieces of pink cauliflower or coral.  The report only says non-muscle invasive which is good news.  Unfortunately there is no way to tell from what is written whether it is stage Ta or T1 as both stages are considered non-muscle invasive.  Your doctor will have to answer this one.  The not so good news is that the cancer was high grade.  The other good news is that no Carcinoma in Situ (CIS) was present.  CIS can be present along with the urothelial carcinoma and is a more aggressive cancer.  It is not unusual to have more than one type of bladder cancer at the same time.

The answer to question 2 means a lot of the muscle layer was in the sample which is good and nothing unusual meaning cancer was found in the muscle part of the sample. That is also good news.

As for next steps/follow up that will be the heart of the discussion when you see your uro.  You will most likely need a follow up regime of BCG immunotherapy or Gemcitabine/Doxotaxcel which is a chemo combo.  BCG is the usual follow up for high grade non-muscle invasive bladder cancer but only your doctor can confirm if this is the right option for you.

I suggest asking the following at your next visit:

1) Ask for a complete review of the pathology report detailing your exact diagnosis so you get a complete understanding of how serious or not serious your situation is. This is where you can ask whether you are stage Ta or T1. It may make a difference as to the follow up treatment protocol.

2) What are the next steps?  BCG? GEM/DOC?  A second TURBT?  Some doctors want to do a second TURBT to confirm the first pathology or to reduce the risk of recurrence.  If the pathology is T1, that is when doctors will often recommend a second TURBT.   Since they did get a lot of muscle sample that looked like nothing unusual was found you may not need this. Ask whether this will be necessary for you.

3) If BCG or GEM/DOC treatments are recommended – how many treatments for how long?  The usual is an initial set of 6 (once a week for 6 weeks) for either of these options and for BCG there are additional sets of 3 (once a week for 3 weeks) at 3,6,12 months from the initial set of 6.  Some patients have more treatments than that.  GEM/DOC is a set of 6 and then usually once a month for at least a year.  If your doctor recommends any of this, he will base his decision on the seriousness of your diagnosis, age and probably if you are dealing with any other health conditions.

Follow up treatment for T1 can vary from having a regime of BCG or GEM/DOC treatments to the urologist recommending an early radical cystectomy.  T1 is probably the trickiest stage to decide treatment on.  If you do end up with a T1 diagnosis it will be very important to feel your urologist out about this one.  Doctors will make recommendations depending on what they feel your risk factors are for recurrence and progression. This part of the conversation is necessary for you to understand so you can become comfortable and confident with whatever decision you make.  Some doctors will let a patient try BCG or GEM/DOC first and see where it goes, some give the patient a choice, others push for the patient to opt for a radical.

I hope this helps.  Best Wishes going forward.  ((((HUGS))))

 

 

 

[Sick_in_YYC]

Thanks Marysue. Your detailed response is very helpful. I appreciate it.

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