Others have given you good advice, so much of what I say will be repeats, but that is not always bad
First, since you have been dealing with other cancers, your are fortunate to be being seen at a place like Hopkins. I feel confident that the expertise is there to cover any problem you might have.
You will be having a TURB, as mentioned above, which does two things. First, it will remove the nodule (tumor?) and second, will provide samples for the pathologist to examine to determine IF it is indeed cancer, and, if so, what the situation is.
They will NOT instill BCG after the TURB. If they do instill something, it will most likely be mitomycin...which IS a chemo agent when administered systemically, but in this case is to prevent any seeding, as has been mentioned. BCG is NEVER administered if the bladder is so much as irritated, since that would provide an avenue into the bloodstream, which you do not want.
Yes, there can be some severe side effects to BCG, but they are rare. Many of us here have been through the series with no more than minor effects. It is possible, even if you have a diagnosis of bladder cancer, that this may not be recommended. It will depend on what the pathology report indicates.
If you still feel that you need a second opinion, there is a list of places with excellent bladder cancer treatment available from the Treatment Center Finder on our home page. Once good place would be Memorial Sloan Kettering in NYC or Mass General in Boston.
There are various tests that can be done on urine samples to see if there are bladder cancer cells present; these are now valuable only as supplements to other diagnostic tests and have issues with both false positives and false negatives. There do not appear to be any genetic tests commonly used such as are done with breast cancer. The "gold standard" of diagnosis is still the TURB and the pathology that accompanies it.
Back to one last question you had on BCG treatments. They are no "big deal" and can be done just about anywhere. I would much prefer to be close to home (and my own bathroom!) In my case, it was administered by a BCG-nurse in my urologist's office and I then headed home. The first four hours or so are a bit uncomfortable, but very do-able. But you are not there yet!!
Any more questions?
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Hi , Sorry you have had the trouble you have had and for the reason you are on here. I have been going to john hopkins since 2006 and I still can,t believe I won't be seeing dr. S. anymore ! Broke my heart.
You might get lucky and find out it is a non cancerous nodule, and then you won,t have to do anything. I don't think they would install bcg when they do the surgery because they want you healed from the biopsy to use it. If it is bladder cancer they might install mitomynicin (IT is a chemo agent )when they do the biopsy that is what they did for me. If it is a simple ta they might not require any other treatment except to do a cysto every several months to make sure it has not come back.
Mine has come back several times over the years but we always catch it early so they just take it out. That might be hard for some people to adopt a wait and see but it has worked for me. If you go back thru the post on this site you can glean alot of info from othe peoples post . It is hard not to worry about the bcg but alot of people get it and don't have to bad a time of it. There will be more people pop up to answer your questions try not to worry to much . Rocky
I think the first "biopsy" will be from a TURBT (surgery) to remove the tumor. The report will be from Pathology, not the surgeon. Now you know what it is, and how to proceed. I contradict your thoughts of BCG. It is not usually instilled after a TURBT because your condition has not yet been identified. Your #4, adverse reactions, needs to be re-evaluated. Side effects may occur, but nothing of major concern. Sounds like you have done online research, which can be confusing. Thanks for stopping here, and others with more 'been there-done that' experience can join in for your questions.
Welcome to The American Bladder Cancer Society's forum.
In answer to your first question: the bladder biopsy does not need to be done by a urologist who specializes in bladder cancer. You should be fine with the Johns Hopkins doctor who is scheduled to do your biopsy.
I am a caregiver and will let others who are more knowledgable answer your excellent questions.
Best wishes to you. It sounds like you have been through a lot the last several years.
I have two primary cancers. Endometrial CA in 2011 and Stage 1 lung cancer in 2012. On my recent follow-up CT, a small enhancing nodule anterior bladder wall suspicious for transitional cell cancer was found. I am told that I will need a biopsy.
I have several questions.
1. How important is it to go to a top bladder cancer doc for the bladder biopsy? I ask this question because the top doc at Johns Hopkins (close to where I live) has just left Johns Hopkins. The other bladder cancer specialist at Johns Hopkins is now doing all of the muscle invasive cancer surgeries and not doing any of the biopsies. I am scheduled to see a Johns Hopkins urologist who specializes in prostate cancer but I have been told that he does do bladder biopsies.
2. Are there new technologies that are important to be used for the bladder biopsy - new cystoscopes, etc. Are there biomarkers that are important to be tested for on the pathology specimen?
3. If I proceed to have a biopsy with this urologist and if the biopsy is positive for cancer, I will want to go to a top doc for a second opinion. Can someone please give me the names of the top bladder cancer docs for bladder cancer?
4. I understand that there can be significant adverse reactions with BCG treatment. When a patient chooses to have their treatment done away from home, how do they handle their post-treatment complication care?
5. I have read that the reason why BCG is instilled within 24 hours after a TUBR is to prevent the cancer from seeding other areas in the bladder. Is the same risk there for bladder biopsies?