LOTS of questions!! First, do I understand correctly that you had a biopsy without anesthesia? The uro just took a sample during a cystoscopy? (OUCH) That is NOT the usual procedure, and if that is what was done, it is no surprise that there is still a mass there. In addition, since there was no muscle or submucosa present, they had no idea whether the cancer was completely localized or not. Usually the uro sees evidence of a problem while looking during cystoscopy, and schedules you for a TURB. During the TURB (yes, under general anesthesia) the entire mass or as much as possible is removed and that is sent to the pathologist. Trying to remove a mass of any size whatsoever and getting the entire thing without anesthesia would be impossible. And often a second TURB is scheduled a month or so later if there is any question at all about the initial diagnosis.
The TURB is not a long procedure, and you will not be under very long at all. It would be very unusual and probably not considered good medical practice to give a spinal for such a relatively minor procedure, but you can ask your doc about this. There are just too many possibilities for some really unpleasant side effects with a spinal!
You may, or may not, have a catheter after the TURB for a day or so. It is more common with males, and depends on how much "damage" the uro does in removing the samples, and where they are located.
You did absolutely the correct thing in seeking a second opinion/consult at Mayo. If you hadn't, you would still be walking around with a cancerous growth in your bladder!!
I guess, to summarize the answers to your questions,
1. No,the way your "biopsy" was done the first time is NOT typical
(and as you can see, not very effective.)
2. The original path report is probably completely accurate CONSIDERING THAT THE SAMPLES SENT TO THE PATH LAB WERE INCOMPLETE. The tiny pieces were analyzed OK, but there was not enough tissue, none of the muscle or lower layers were included so no one knows if the tumor invaded them or not.
3 & 4 ...think I already answered
5. The biopsy was very incomplete. All the report told you was that there was low grade cancer in those pieces. In addition, he left most of the tumor there instead of removing it. In my case, my first TURB showed low grade papillary tumors, and some areas of "irritation" but the pathologist was unsure what it was. Back for a second TURB and the "irritation" turned out to be high grade CIS! Without the second look, I would have been in big trouble! The TURB you are going to have should give you a more complete diagnosis.
6. It isn't the size so much as the grade and extent that it may or may not have gone into the muscle and other layers of the bladder. That is why you need the TURB. You and the new urologist will then be in a much better place to discuss treatment.
With a little luck the path report will still be low grade, non-invasive. And you will be confident of the diagnosis.
Will keep my fingers crossed for you
Sara Anne
Topic Author
