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Help with questions for 2nd opinion

9 years 9 months ago - 9 years 9 months ago #32179 by mmc

Sorry to hear about your dad's situation.

First, he's already been diagnosed with high grade bladder cancer. You do not want to try to randomly figuring out if a urologist is the right one or not.

He needs to get to a top bladdder cancer doctor at a major bladder cancer center. He needs a TURBT with full margins and the pathology report to be read at a top bladder cancer hospital. Yes, even the pathology doctors are better at the top hospital.

Other than making sure they are not bladder cancer, I wouldn't worry so much about the other things found. Cancer wins when it comes to prioritization.

A TURBT is the next step that he needs to get staging. There is typically another one done within six weeks of the first. You mentioned that you were in the medical field. That's good because you will already understand the difference in levels of specialty.

As you know, a urologist covers all urological diseases and conditions, the same way a general physician covers the whole body. Once you know you have bladder cancer, you get a referral to a top urological bladder cancer specialist. They are better at doing TURBTs and tend to get good margins the first time.

They also are better at determining the treatment option with the best outcomes.

Let us know where your father lives so we can recommend a top doctor/hospital in his area.

I am not a doctor but I am a patient with a good bit of experience who has done a lot of research. In the meantime, I suggest reading this post I wrote previously: Major Bladder Cancer Hospital Within that post is a link to a guide I put together to help bladder cancer patients understand the path(s) through this. Here is that link: Patient Guide to Bladder Cancer Treatment

Read these as they may help you.


Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...

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9 years 9 months ago #32178 by hopeful1
Hello all! I hope everyone is doing well or at least getting there.

I need some advice, suggestions, anything really.

So here's my story:

My father has been experiencing blood in his urine for a month. He finally told my mother and then had my mother ask me about it. (I'm in the health care field. My father is 63, I'm 23. He's awkward about certain topics like this). My father is known to randomly pick up TV's and feel the need to remodel our house and things like that. Four years ago, he had a hernia repaired, so I figured he probably pulled something and that's what he was experiencing. When I saw the blood, I got very scared. This was no "red tinge", there was fresh, bright, blood and a decent amount of it. I asked him if it burned or hurt at all, nope. About 3 weeks before he told my mother and i this, I started to realize he was getting up in the middle of the night to urinate, almost 2-3 times a night. That was very out of the ordinary (I feel so guilty about not realizing this sooner and asking him what the deal was with this sooner.) Anyway, the next day, i called a urologist that was referred to us by his general physician. He ordered a urinalysis and it came back with a few WBC. He ordered cytology and blood work and a CT scan. On the 17th he had a cystoscopy done, and they did a biopsy. After the cystoscopy, the urologist told my parents that it's cancer, schedule a TURBT with him in a nearby clinic and pretty much sent them on their way.

What bothers me the most is that you don't just tell someone they have cancer and good day! SEE YA LATER! My parents would pretty much have no clue what bladder cancer even is if it weren't for me researching day and night about it. That same day, I went back to urologist's office to request some files, particularly the CT scan. My father had ultrasounds and x-rays and CT's because of his hernia four years ago. There are renal cysts (I know they're common) and a 4cm bilobed cystic structure in his inguinal scrotal region, that were not there according to his scans and what not 4 years ago. None of this was even brought up to my parents. Since i was already unhappy with this urologist, I started looking for second opinions. On Thursday the pathology report came back.

This is what the report says:
papillary transitional cell carcinoma, moderately to poorly differentiated (high grade), necrosis

All the urologist told us was that it's high grade. Staging isn't able to be done because no subcutaneous or muscle wall tissue was biopsied. Understandable. Well I have second opinions scheduled (3 of them). Now I'm preparing a list of questions. Because I know that we don't have the staging, we are limited with information. However, we want to continue with treatment (if necessary) with the doctor that preforms the TURBT.

I really need advice on what questions I should focus on asking and what we should think about while making our decision when it comes to choosing a doctor.

Thank you for all of your help and time. There's just so much information to read and sort through, so i have so many questions about so many things. I know that our time is limited with initial consultations, but somehow i'm supposed to gather enough information of who I'm going to entrust with my father's life. Someone said to rate them from most important to least important. ALL of it is very important to me. I just need a few suggestions of what to ask to just get us started and how to "grade" each doctor I suppose.

Thank you!!!

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