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Clarification please?

10 years 3 months ago #20961 by dmartin12358
Thanks for the link, Pat. It was excellent. It's often best to read medical explanations that are written by an expert, than to have them paraphrased.

Dan

Dx 7/04, CIS + T1G3, Age 50
2 TURBTs
12 BCGs
Cystectomy 8/05 USC/Norris
So far, so good (kow)

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10 years 3 months ago #20960 by sara.anne
Patricia, that was a very interesting article. I have several paragraphs copied to take to my urologist when I go in for my maintenance BCG next week. The part that I find disturbing, and similar information from the ABCS site info, is that most CIS is associated with invasive TCC in adjacent or distant urothelium. Both sites state that primary CIS occurs independently in about 1% of cases. This is the part that has me "freaked out."
Thanks....will let you all know what Dr. Janoff's interpretation of this is...

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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10 years 3 months ago #20954 by Patricia
From the Pathologists viewpoint.....hang in there..its tough reading ...there is Primary CIS and Secondary CIS.......i think this explains why you want a really really great pathologist......
http://www.moffitt.org/moffittapps/ccj/v3n6/patholog.html
Pat

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10 years 3 months ago #20952 by sara.anne
Dan, thank you for your thoughtful response. Just when I think that I have a handle on this, it squirms away. May I ask for one more clarification? You said

"Also keep in mind that there are different types of CIS, one form being more aggressive than the other. There are some on this website who seem to have had the less aggressive form of CIS and have had no recurrence after many years. They may never have a recurrence."

Are you implying that there are two diagnostically different forms of CIS or does your interpretation come from the outcomes of different people?

Thanks again

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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10 years 3 months ago #20951 by Patricia
I don't know Dan...but i did have CIS along with one tiny little papillary tumor which turned out to be T2 and invasive to the first layer of muscle..it also was a lower grade CIS. I was happy that i was in a first class cancer institution with a world class surgeon and pathologists who said....Get that bladder out..NOW. Pat

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10 years 3 months ago - 10 years 3 months ago #20950 by dmartin12358
Hi,

This can be confusing, it's complex, not perfectly understood by urologists (nor me!). And all of us here have panicked at one time or another, so you're in good company. <g>

Here's how I look at it:

1) CIS is one of several forms of TCC (transitional cell carcinoma)

2)"associated with concomittant high-grade invasive TCC" means that if CIS is found in the bladder, it is then often also found elsewhere in the urinary tract (urethra or ureters or pelvis of the kidney), and/or that it is found with papillary (not muscle-invasive) or T1 (not muscle-invasive) or T2 (muscle-invasive) cancer in the bladder. I interpret invasive CIS to be CIS that that has progressed from the lining of the bladder to the lining of the ureters or urethra or pelvis of one or both kidneys. Note that T2 cancer is invasive differently, in that it has invaded the muscle of the bladder. CIS and T2 can both become metastatic.

3) "Is it usual that it has already spread?" I don't have the statistics on that, but there are many on this website where tests did not show CIS had spread at the time of their original diagnosis.

Also keep in mind that there are different types of CIS, one form being more aggressive than the other. There are some on this website who seem to have had the less aggressive form of CIS and have had no recurrence after many years. They may never have a recurrence.

4) Many studies have shown that BCG can often delay recurrence and progression of high-grade TCC, shorter-term. But BCG has not been shown to prevent recurrence or progression, longer-term. Many doctors and patients use the word 'control' in that if the patient undergoes careful surveillance, then recurrence of CIS might be detected soon enough to allow for additional, more aggressive or definitive, therapy.

CIS found with TaG3 or T1G3 is known to be more dangerous than CIS found alone, or TaG3 or T1G3 found alone.

Dan






I find that I always learn new things when I re-visit things I have already read. I was perusing the section on CIS under the BLC information of this web site, and was struck by the following excerpts..

"CIS-carcinoma in situ, is relatively rare, comprising approximately 10% of cases and is also considered a superficial tumor (does not penetrate the bladder lining), and is usually associated with concomitant high grade, invasive TCC in adjacent or distant urothelium (secondary CIS).

Occasionally (1% of cases or less), CIS is found without associated invasive TCC (primary CIS"


QUESTION: what does the part about "usually associated with concomitant high grade invasive TCC..." mean? I was under the impression that CIS was "controllable" with BCG, or, at worst, bladder removal. Is it USUAL that it has already spread? Guess I am in a bit of a panic, confused.

Dx 7/04, CIS + T1G3, Age 50
2 TURBTs
12 BCGs
Cystectomy 8/05 USC/Norris
So far, so good (kow)

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