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.