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Post BCG Check

1 year 9 months ago #52931 by Mistersac
Just wondering what % of non invasive CIS evolve into a need for bladder removal. My URO days that there is an 80/20 chance of a cure, and he hasn't replaced a bladder in over 5 years.

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1 year 10 months ago #52820 by Jack R
Mistersac,
I wondered about that too. So many fine points about BC.

A clear explanation of why a TURBT may be advisable when only CIS is present is on page 1 & 2 of an article authored by Michael O'Donnell, a source I trust. Obviously, there is a range of CIS involvement, from minimal to extensive coverage of the bladder; physician judgment will determine the need to biopsy CIS.

O'Donnell cites the Prognostic Factor of CIS. My Urologist explains it thusly, "When I see lots of CIS on the surface, I have to wonder what is below".

CIS is always considered aggressive or high grade, and must be treated. It can't be both of those things and also be described as "only a superficial surface rash". O'Donnell explains:

"Tis — Tis (also called carcinoma in situ [CIS]) is characterized by severe cellular dysplasia in the absence of discrete tumor formation. Areas of mucosal involvement with Tis are often found in association with invasive disease. The presence of Tis in the mucosa adjacent to a Ta or T1 tumor appears to increase the risk for muscle invasive disease [5-8]. The potential prognostic significance associated with Tis is illustrated by a multicenter series 243 Treatment of non-muscle-invasive bladder cancer patients who underwent radical cystectomy for carcinoma in situ without more invasive disease [7].

"Staging based upon the cystectomy specimen revealed that Tis, T0, or Ta in 48, 8, and 8 percent of cases, respectively. However, T1, T2, T3, and T4 disease was detected in 13, 12, 5, and 6 percent of cases, respectively. Lymphovascular invasion and positive lymph nodes were found in 9 and 6 percent, respectively.

"The presence of Tis without invasive urothelial cancer is associated with a high incidence of progression to invasive disease, even after transurethral resection and treatment in intravesical BCG. In a retrospective, single institution series of 155 patients managed with transurethral resection and intravesical bacillus Calmette-Guerin (BCG), the five-year cumulative incidence of progression to cT1 or higher disease was 45 percent (95% CI 37-55) [8]."

Full article at:
http://ether.stanford.edu/urology/Treatment%20of%20non-muscle-invasive%20bladder%20cancer.pdf

Best
Jack

What's with this Bleeding ? 6/2015
DX: HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
T0 CIS comes back.
BC clear as of 5/17 !
RCC found in my one (only) kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo , round 3
Begin year 4 with cis T0

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1 year 10 months ago #52819 by Mistersac
If there is a tumor present does that constitute BCG failure, or would another cycle of BCG be effective?

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1 year 10 months ago #52817 by sara.anne
CIS looks like a rash on the surface of the bladder. The uro can get a pretty good idea of what is going on
since he saw it before and now after BCG. If he has any doubt, he will do a TURB.

I had CIS and was monitored every three months along with the BCG. Twice he saw irritation and even though he thought it was BCG-induced cystitis, he took a quick small biopsy right there (a little bit of OUCH, but not bad)
and confirmed that it was NOT CIS.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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1 year 10 months ago #52810 by Mistersac
I thought with CIS being on the surface of the bladder that the URO would have to biopsy to see if there is a tumor. How do they tell with just a cystoscopy?

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1 year 10 months ago #52808 by sara.anne
It is usual to have cystoscopy 4-6 weeks after finishing BCG. The urologist takes a quick peek and you are good
to go. If, however, he sees evidence of a tumor again he would probably schedule a TURB....but that is not common.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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