Here is my update after having read through mother's medical file:
Sometime during the spring cardiologist noticed microscopic hematuria and referred mother to urologist.
On 4/29/09 mother visited urologist, who noted "papillary tumor present on left lateral wall. No significant trabeculation noted." Urologist notes: "malig neo posterior wall bladder"(Can he diagnose tumor as malignant without pathology?) Urologist scheduled "Cysto/Bladder Bx/Fulguration (hosp)."
On 5/28/09 urologist performed "cystoscopy and TUR of bladder tumor." Post op report states: 2-3 cm tumor - low grade papillary appearance - no other tumors found. Tumor removed with no problems. Follow-up scheduled for approx. 3 mos. Pathology report states: "Papillary urothelial neoplasm of low malignant potential (PUNLMP). No evidence of invasion of subepithelial connecting tissue seen. Code 9, Class III, ICD-9 236.7" "In WHO/Koss grading system, this corresponds to grade 1 papillary transitional cell carcinoma, noninvasive." (Question: was this tumor malignant or benign "potentially malignant"?)
On 6/8/09 Mother visited urologist complaining of a bladder infection. After dealing with that issue they discussed her cancer. He explained he wanted to do cystoscopy again rather than treat with medication. She agreed to a followup cystoscopy on 9/9/09. Cytology was negative.
On 7/31//09 mother presented with kidney stone. After dealing with that issue (decided to let her try and pass it like she had with previous stone), urologist took opportunity to again discuss cancer treatment plan and again discussed cystoscopy versus medication. Mother agreed to followup cystoscopy on 9/9/09.
On 9/9/09 mother presented with bladder infection and kidney stone pain. After dealing with those issues, urologist performed in in-office cystoscopy and noted "very small bladder tumor on right lateral aspect of bladder. This is obviously papillary and low grade." He further noted that she "would not tolerate procedure under local" and ordered a day surgery fulguration of the small tumor. Mother agreed.
On 10/6/09 urologist performed TUR on the recurrent tumor on the right side bladder neck. Although he said tumor singular he later notes tumors pleural (FWIW). Post op notes state: " . . . two obviously low grade papillary tumors, the first and smaller one was removed on its stalk, but basically dissolved in the process. The second was removed using two cold punch biopsies. The area around the base was slightly bubbly and was not totally normal and was included in the second biopsy." The area was then fulmugated widely. No other tumors found. The pathology report notes: Tumor from right side of urinaryy bladder neck, TUR. Low-grade noninvasive papillary urothelial carcinoma. Code 9, Clas III, ICD-9 233.7 It then goes on to state: Pathologic tumor stage: Ta Nx Mx
On 12/7/09 mother returned for a followup visit. Urologist ordered follow up in-office cystology for 1/23/10. He also discussed "in great detail" "the diagnosis of transitional cell carcinoma of the bladder." He is recommending BCG for at least 6 treatments. (note that mother said he recommended chemo - clearly she was confused by the discussion). He gave her some literature on the subject, asked her to consider BCG and said they will again discuss the issue in Jan. during the next visit.
So, bottom line is that she definitely has bladder cancer with a recurrent tumor. It sounds like the tumors were malignant but non-invasive and localized. Probably the best situation with the highest survival rate?
I'm still trying to get my arms around all this and need to be able to explain it all to mother since she tends to the dramatic and focuses on the negative rather than the positive. I'm hoping that this is all good news or at least as good as it can be. Any and all help with explaining the prognosis and procedures (especially BCG) will will be greatly appreciated. Mother seems to be a bit leary of her urologist but after reading the file and looking at Mike's flow chart (thanks Mike for that - it is extremely helpful) it seems to me that he is going by the book.