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How Serious is this Pathology Report

6 years 4 months ago #42708 by hipressr
Thanks Alan. The uro did say it is a PTA tumor. I am upset that they gave her epidural rather than anasthaesia, the uro said it is normal to do an epidural. Had I known that previously, I would have fought to do anasthaesia and remove it all....

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6 years 4 months ago - 6 years 4 months ago #42706 by Alan
As the others have posted a second opinion is in order. I am surprised they gave her an epidural. Almost all of us are given a general anesthesia for a TURB. Yes, as my first post you want all of it out if possible plus margins on the chance to determine staging, I was surprised they only got 1/4. Stage 1 (non muscle involvement) versus stage 2-4 (muscle or further) will help both of you determine what to do. It certainly is complicated with your Mom's general health-I have too many friends dealing with Parkinson's. A sub specialist not just URO, at the best bladder center is where I would aim for. Someone on this board should have an idea where to go in Quebec. If this isn't available, many times a good teaching hospital would be the next option if they treat a volume of bladder cancer patients. Keep asking questions, someone will have help!

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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6 years 4 months ago #42704 by hipressr
Thanks Sara Anne,

We are from Quebec, Canada. The Uro is head of urology and teacher at the school of medicine, The radiation is palliative right now to stop the bleeding as she has for 3 weeks after the Turb and has received numerous blood transfusions.... I need a second opinion as there is a lot of conflicting info, it seems they have written her off based on her state and the size of the mass. At first, they gave her 12-24 months, but they said it could be 36-48 months as well, they do not know.... appreciate your input

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6 years 4 months ago #42703 by hipressr
Thanks for all your comments.

MMC, Yes you are correct, the sample was 10x6x1.5cm in size. According to the echo, the mass is 8.2x7.4x7.6cm. Do not know why one is 10cm and the other 8.2, maybe it is the way the pathologist collects the samples. The CT shows no spreading outside the bladder, no lymphodenopathy. The Uro sees that the bladder wall is somewhat distorted yet ct shows no spreading, maybe tumor too large and distorting women's thinner bladder?? He also said he was able to scrape muscle during the turb however the pathology shows no muscle was sampled and whatever tumor was sampled was non-invasive. She got an epidural for the procedure, apparently the goal was to get samples for the pathology, she was not asleep as they did not want to use anasthaesia unless necessary. The pathology does say no invasive neoplasia, so i guess they would need to remove all of it to make an informed decision? I appreciate your input.

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6 years 4 months ago #42701 by sara.anne
I would second Mike's recommendation for a second opinion. With your mother's fragile health status, and the relatively strange report (only 1/4 of the tumor?)
it would appear that she really needs to be seen by an expert. If you tell us your geographical location, we may be able to make some suggestions for you.

It appears that the urologist is in over his/her head and has sort of "written her off." If her diagnosis is as you stated, unless there is more to it, there should be other options. I would want a second opinion in any event before considering radiation.

Your mother is very fortunate to have you with her.
Best of luck to you both.

Sara Anne

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

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6 years 4 months ago - 6 years 4 months ago #42695 by mmc
He only got 1/4 of the tumor but that was over 4 inches by 2.4 inches by .5 inches????

Holy crap! That's huge.

Usually they measure these things in centimeters but I guess they do things differently where she had hers done.

Nobody can say that this is not-invasive based on only removing 25% of the tumor. If he's already giving out a prognosis like this, one would expect the urologist is pretty sure this has already become invasive if not worse.

Another major concern is that the doctor said she was under quite a lot of discomfort so he couldn't get the rest of it. Wasn't she asleep under anesthesia?

Again, the pathology really only tells you she has high grade bladder cancer. Without removing the rest of the tumor, it is a guess at best.

Her urologist may be making some judgment calls based on her level of Parkinson's, her frailness, and how much he thinks she can take.

A second opinion from a bladder cancer specialist is in order. Her overall health has to be a serious consideration also. If her health is so bad that she can't really tolerate any kind of treatment then giving her treatment of any sort may do her more harm than good. Only the specialist can make that call.

Sorry your mom (and you) are facing this situation.

Mike

Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...

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