Chest Xray

[JazB]

Hi everyone I went for my 3 month cystoscopy yesterday and recieved the all clear. Afterwards my urologist provided me with a requisition so that i can get a chest xray of my lungs. He said that if you have high grade bladder cancer it is protocol to get an xray of the lungs every 2 years. Has anyone else with non invasive bladdee cancer have to get a chest xray? Is there a chance that this cancer can still spread to other parts of the body if the cystoscopies are showing all clear for cancer. I was diagnosed with TAG3 bladder cancer 2 years ago and am scheduled for my next set of maintenance BCG in November. Any insight would be appreciated.

[Nightingale]

Hi JazB,

Thank you for sharing your story in the Forum.  I personally have not heard of needing to have x-rays done every 2 years, but lets see what others have to say.  Keep well and all the best for your upcoming BCG in November.

My best,

 

[marysue]

Hi JazB:

I have been diagnosed with TaG3 three times and never been sent for a chest x-ray and neither of my two urologists have ever mentioned it being protocol. My treatment protocol has always been TURBT surgery to remove the tumours followed by BCG treatments with cystoscopy checks in between treatment sets.  The only difference the 3rd time around was that Epirubicin was instilled in my bladder immediately post TURBT for 1 hour.  My uro was hoping that this would have meant it to be a one and done and I would not need further BCG treatments but when the pathology came back he wanted me to do another round of BCG as well. Not fun.

However that being said, there is protocol and there is protocol.  There can be a standard protocol for treating a particular health situation and then there can be the doctor’s protocol for treating the situation.  Protocol procedures can vary between doctors as well.  This can make it rather confusing for a patient if they discuss their medical situation with another patient and discover that the treatment protocols are different even though they may have the same stage and type of disease.  Doctors usually develop their protocols based on their initial training and then their personal medical experiences with patients.  I also believe (but don’t have any real proof) that doctors of all stripes develop a sixth sense over time and that may influence what they decide for a patient.

That question about there being possible lung mets even if the bladder seems to be clear of cancer is a valid one and would be a good question to raise with your doctor.  He may be prescribing the extra test as a precaution and to cover all the basis based on his experience with bladder cancer. I have read and heard that yes, it is possible for a secondary cancer to show up after having bladder cancer.  I do know of a couple of women who originally had breast cancer and later got bladder cancer.  It is also possible for a later recurrence of bladder cancer to be a totally different type of bladder cancer.  This happened to me in 2022.  In 2008 and 2010 I was diagnosed with urothelial carcinoma – the most common type of bladder cancer that looks like pieces of pink coral or cauliflower.  Twelve years later in September 2022, I was diagnosed with CIS (Carcinoma in Situ) which is a flat lesion patchy type of bladder cancer and is usually reddish in colour.  Although my CIS did not look like that.  My uro told me that it was an extremely early cancer and it was a yellowish tan colour and looked like a patch of sea kelp.  It was pathology that confirmed it was CIS.  Since I was cancer free for 12 years I thought that I had it beat and so did my urologist.  He initially wanted to cut me loose after 10 years clear in 2020 but I told him I didn’t trust it and wanted to continue with annual check ups.  I’m so ever glad that I did that because if I had cut loose the CIS might not have been caught as early.  I had absolutely no symptoms to alert me that something was wrong.  The previous two times, I had blood in my urine so naturally I went to my doctor to get it checked out.

Anyhow, these are my thoughts.  I suggest a further conversation with your doctor re the lung/chest x-ray to get more clarification as to why he feels it is necessary.  All the best.  (((HUGS))))

[Joe]

Hi JazB,

I was diagnosed as TaG2/3 intermediate risk.   I had regular cystoscopy every 3 months, then every 6 months and then moved to annual cystoscopy.   My urologist did not find anything, but my urologist prescribed ultrasound of kidneys, then CT Urogram after 3rd year, and recently cytology.  All three did not find any abnormality except CT Urogram found a 2mm size kidney stone, which my urologist said not to worry during the telephone call after the procedure.   I did not have X ray specifically though CT Urogram also took images of my lungs.   My relationship with my urologist is distant, so I don’t ask the reason for those procedures., but I am glad I had those done as it assures that cancer had not spread to other parts of my body.

Though it is very rare, technically it is possible that bladder cancer spread to other parts of body even when diagnose TaG3 and cystoscopies have been negative.   Bladder lining consists of urothelial tissue (Ta), connective tissue (T1) and muscle tissue (T2+).   A literature says TaG1 tumors approximately progress to muscle invasive, but it is extremely uncommon for TaG1 to metastasize without evidence of local invasion.  The 2018 study says there are less than 30 cases of TaLG metastasis reported in literature, and the most frequent site of metastasis are lungs.  So, it makes sense to check lungs with X ray periodically even if TaLG with no evidence of cancer by cystoscopy.  Your case was TaG3 or TaHigh Grade (HG).  TaG3 is considered higher risk than TaG1.  Cancer cell with G3 has characteristics of its tendency to separate itself from other the cancer and progresses to connective tissue and muscle tissue, and squeeze into blood vessel and lymphatic vessel and move to other parts of body, so it makes more sense for additional check up, eg. X ray to check lungs.

Though I could find surveillance algorithm for non muscle bladder cancers,  I have found it at MD ANDERSONS Cancer Center, which is listed in top 5 hospital with urology in the US.   Their surveillance program recommends X ray every year for 5 years.

tinyurl.com/ypjhrsh6

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