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[Brr679]

Hello Everyone,

I am a 61 year old female.  I just got CT scan results back and I am awaiting appointment with urology at one hospital and then another hospital has called referring my file to oncology.   I live in Quebec.

Up until now, I have been in good health.

My CT Scan stated “There are multiple polypoid bladder masses present, the largest of which encases  the right ureterovesicular junction, and measures up to 3.9 x 3.4 cm”

Does anyone have any expérience with this type of situation.  I have read a bit about bladder cancer ( I know it would still need to be confirmed by a doctor) spreading beyond the bladder wall.  I am curions, if the mass is in the right ureterovesicular junction, does that medically mean it has spread beyond the wall?

 

I would appreciate any information as I wait for my appointments and do additional reading.

 

Thanks again,  There is so much helpful information

 

Ruth

[Joe]

Hi Ruth,

How is everything going?  I am curious to know what led you to have the CT scan done.   Your questions are something you want to ask to your doctors. Meanwhile for entertainment sake, I will try to answer your questions as you requested.    I usually get the CT scan images from the hospital and try to view it myself, but I find it interesting but difficult to understand it well.   I was able to locate the image of a 2 mm kidney stone which the report said, ha.

Anyway, I was checking a few articles on CT scan imaging and medical terminology.  A lesion is  considered polypoid if it protruded into the bladder lumen and is attached to the bladder wall by a narrow stack.  The mass can be benign like papilloma  or cancer.  Papilloma tends to be found at single site and tends to be small.    The right ureterovesicular junction (UVJ) is just where the right ureter meets bladder.  So, the largest tumour encases seems to mean that the right ureter is covered by the tumour of 3.9 x 3.4 cm.  Yet, the report does not say hydronephrosis of the right kidney, which is a condition where the right kidney becomes stretched and swollen as the result of a build-up of urine inside them due to the blockage of urine.  Also, the report does not say that the right ureter is dilated meaning that the right ureter is stretched or widened.  So, it sounds like urine from the right kidney seems to be coming out to the bladder normally even if the tumour is covering up the right UVJ.    Incidentally, I don’t think the tumor has not spread beyond the bladder wall or even invaded the muscle layer of the bladder wall because the report should say so if that is the case.  I have looked at CTC images of transitional carcinoma and it is obvious to me.   You can look at sample of images of bladder cancer in American Journal of Roentgenology (Radiology) – see the following link.  I think most images are by MRI, but CT scan should give equivalent images.

“ajronline.org/doi/10.2214/AJR.17.17798”

Fig. 1A -Non muscle invasive T1HG, papillary type tumour.

Fig. 2A –  T3HG, muscle invasive bladder cancer.

Fig. 3A –  T2HG , muscle invasive bladder cancer at two sites 5 weeks after initial TURBT.   The second TURBT was done to resect those two tumours.

 

• This reply was modified 1 month, 3 weeks ago by Joe.

[Brr679]

Hello Joe,

Thank you very much for some information.  I appreciate your information and I know that I will need an assessment for a definitive diagnosis.

FYI, in my particular case, about 3 weeks ago I was out for a long walk and when I returned home I had a lot of pain in my hip area.  I just took it easy  the rest of the day and it went away.  The next evening , I was out for a short run with my daughter and when I returned home I noticed a fair bit of blood in the urine.  I booked an appointment at our emergency clinic and the doctor thought a CT scan was in order.  It is interesting because I did a quick test at home for a urine infection and the results showed blood but no infection ( which I mentioned to the doctor).

I have already met with a Urologist and I will be having a cystoscopy  the middle of next week.  I will definitely give you an update on how everything progresses.

Thank you again ,

Ruth

 

[Nightingale]

Hi Burr 679,

Almost 15 years ago, I was in a 5k race and at the end, I had this tremendous urge to pee.  When I did, it was a stream of blood. Scared to death, I contacted my doctor and he immediately booked me to see a Urologist.   Turned out I had what they call PUN LIMP.  Very low grade non-muscle invasive cancer.  Today some argue it’s not cancer.  Mine was close to the ureter coming from the right kidney, so when I went under for the first time, they went up into my kidneys to make sure the cancer had not spread.   Mine came back 3 times.  I never had any BCG treatments.  Here I am, coming up on 15 years, and going strong.

I hope you get good news.  If you want to talk on the phone, let me know and I will arrange for a phone call.

My Best,

[Brr679]

Hi Nightingale,

Thanks for the offer.  Will keep posting on how things develop.

[marysue]

Hi Burr679:

I too, passed copious amounts of blood one afternoon in June 2008 after coming home from an afternoon shopping trip.  When tested there was no infection present, only the blood so that was when my doctor agreed with me that the issue was something else other than a UTI.  I was sent for x-rays and an ultrasound and that was when the tumours were discovered in my bladder and my journey went from there.

The wait to find out exactly what your journey will entail is tough.  We’ve been there.  We all want things done yesterday and it done in 5 minutes or less.

Hopefully the news of the results will be favourable.  Fingers crossed and prayers said.  Let us know if you have any questions.  ((((HUGS))))

[Brr679]

I had my cystoscopy yesterday.  Everything went well and they did a urine cytology too.  No biopsies were taken.

The Urologist scheduled me for TURBT surgery in about 1 1/2 weeks and said the surgery will probably be followed after 6 weeks with BCG.

Just curious, is that the standard treatment if people have multiple tumours?  I guess with there being multiple masses, they are  certain it is cancer.

 

Ruth

[Joe]

Hi Ruth,

Thank you for updating us the progress.   As you may know already, the adjuvant treatment after TURBT depends upon several factors.  I am guessing that the fact your urologist is saying that the TURBT will probably be followed by BCG indicates tumours are likely non muscle invasive (NMIBC).    Canadian Urological Association (CUA)’s guidelines for NMIBC state that the only time that does not require some sort of intravesical treatment, i.e. BCG or chemotherapy, is if it is low risk NMIBC.   It is low risk if it is the first time, a solitary, papillary type, less than 3 cm, the stage is Ta and it is low grade (LG).   Ta is when the tumour is within the epithelial tissue layer and not progressed to the lamina propria/connective tissue layer (T1).    The CUA guidelines classify any high grade (HG) as high risk.   Intermediate risk for low grade NMIBC, either multiple, greater than 3 cm, or recurrence.   Typically, low risk NMIBC is surveillance only.  Intermediate risk is either intravesical BCG or intravesical chemotherapy, typically for one year.  High risk NMIBC is usually treated with intravesical BCG for up to 3 years.   But the guidelines are guidelines and ultimately I think the urologist will recommend treatment based upon various factors, including the urologist’s clinical experience.

Cytology – The Paris Reporting  System (TPS) will only report high grade NMIBC , basically a) Negative for High Grade Urothelial Carcinoma, b) Suspicious for High Grade Urothelial Carcinoma, and c) High Grade Urothelial Carcinoma.  There are other reporting categories in TPS, but not mentioned here. I think cytology will help the urologist validate the result of the pathology report.    I do not think those masses are determined to be malignant yet.

 

 

[Brr679]

Hi Joe,

Thank you for the clarification and additional information.

 

Appreciated  : )

[Nightingale]

Hi Ruth,

Good to see your update in the post.  I’m getting the sense that your urologist is suggesting BCG as a precautionary measure.  As Joe implied, every situation is unique and depending on the experience of the urologist, he/she may lean towards a particular treatment method.  I my post above I indicated I did not receive any BCG based on my Urologist’s determination that it was not necessary.  He did indicate to me after the third recurrence that if it came back again, then he would prescribe BCG treatments.  Luckily, it did not.

Wishing you an ‘uneventful’ turbt with good news for you.  Let us know how it goes.  BTW, in the event you’re interested in hearing what other patience are experiencing first hand, and interacting with them real-time, I’m enclosing the link to the Support Groups held across Canada.  Click here

My Best!

[Brr679]

Hi Nightingale,

Thank you for the link, I will definitely sign up for the support group.  I  Will keep you posted on how everything goes once I have recovered from surgery and gotten pathology  report.  Thanks again- this has been a very helpful site with a wealth of information.

Regards

[Brr679]

Hello,

I wanted to give an update.  I had my TURBT surgery on November 4th.  I was kept in the hospital overnight because of bladder perforation ( CT scan the next day confirmed no perforation).  I was sent home the following day with catheter which was removed  10 days later.  The recovery has been good- took the advice about drinking LOTS OF WATER and very little coffee.  It really helped.

I have since received the pathology results. T1 NMIBC High Risk. I am booked for another TURBT in December.  I will be meeting with an Oncologist in early December.  I would imagine the results of the next TURBT a will be the next decision factor- thought I had read many people move up ie. NMIBC toMIBC at time of second TURBT a which would change the direction.

Thanks BCC for all the great information online.  It has been very helpful.

Any input is appreciated.  I a have read many individuals with T1 respond very well to TURBT and intravesical therapy while others demonstrate high rate of recurrence/progression.  I am thinking because I had multiple ( I believe 6) I might be leaning toward recurrence/progression.  Of course oncologist will discuss and at the end of the day they are the experts but always open to hearing thoughts.

 

 

 

 

 

[marysue]

Hi Brr679:

Good to hear about your update.  Often when a first TURBT shows that it is T1 meaning that the cancer has just gone under the inner surface of the bladder wall to the layer called the lamina propria, a second TURBT is often recommended to confirm the diagnosis of the first surgery and make sure that it is actually Stage 1 and not Stage 2 which is muscle invasive and is a whole other animal to deal with.  It also helps prevent recurrence because a second surgery will remove more tissue and/or potential remaining cancer cells from the same area.  T1 is a tricky stage to treat and requires much discussion with your doctor to determine potential risks for recurrence and progression.

Some doctors will treat T1 more conservatively if they feel that the risk factors allow for it which usually means a follow up bladder treatment protocol with BCG or another agent like the newest combination of Gemcitabine and Doxotacel after the second TURBT .  Others want to be more proactive and aggressive and may recommend having the bladder removed.  Some patients are given a choice.  If a patient is given a choice some factors to consider are obviously the risks involved with each option and a person’s feelings about the idea of bladder removal surgery.   Some people feel very strongly about keeping their bladder and will work with their doctors to try all other options first before undergoing the bladder removal surgery.  Others feel that they don’t want to deal with the risk and will decide to bite the bullet so to speak and do the surgery to get it over with and in their minds they might feel that they have lessened the risks because they chose to do the surgery now rather than later.

These are big decisions to make no matter which way you go and will most likely require multiple conversations with your medical team.  Once you know the results of the second pathology you will know for sure which road you are on. Don’t hesitate to post any questions here.  No question is a dumb question.  Once you know what road you are on you can always request a peer support call if you want to talk to someone.  Best of luck.  ((((HUGS))))

[Guyyy]

Moi je viens de savoir que j’ai un cancer de la vessie il m’a dit cancer superficiel j’en ai deux je me stress beaucoup à savoir si je vais vivre longtemps si ce cancer de guéri bien genre pourrais-je vivre encore 15 ans avec cette maladie

Merci de me répondre je suis super stresser

[Nightingale]

Hello Guyyy,

I’m posting your question here in English so other might be able to add their comments and questions –

I’ll post in English and you can use Google Translate to translate into French.

First, thank you for joining and posting your question.  I have several questions for you to ask your Urologist.

• Explain what is meant by superficial cancer
• What does “I have two” mean.
• Your survival rate is dependent on the type of Bladder Cancer you have.  Example: A person with high-grade muscle invasive bladder cancer has a low likelyhood of retaining their bladder than someone with low-grade non-muscle invasive bladder cancer.
  • I myself had low grade non-muscle invasive bladder cancer and am a 15 year survivor.
  • There is a very good Support Group in Montreal where you can converse in French with the facilitator and other members.  Check out their information in this site Bladder Cancer Patient and Caregiver Support Groups | Bladder Cancer Canada
• I hope this helps a bit, but to help you further, we need more information

Merci!

[Author]

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