To BCG or not?

11 years 6 months ago #43107 by Alan
Replied by Alan on topic To BCG or not?
Mike is correct about if it is T1. Second TURBS are routine to rule out errors and get margins.

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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11 years 6 months ago #43104 by mmc
Replied by mmc on topic To BCG or not?
Paul,

Did it say "T1"? What is commonly referred to as "superficial" (which not a great word to use because it makes it sound trivial when it isn't) is typically called T0.

This makes a HUGE difference. If is T0G1 (only on the surface and not into the innermost wall of the bladder and low grade) then "wait and see" is typically the recommended action.

If you were to have a tumor come back in 90 days then, by definition, that is not low grade.

Low grade has a higher recurrence rate but they are very slow to form and grow.

Low grade is a "good thing"! :)

If it truly is T1, they should do a repeat TURB to be sure they got clear margins all the way into the muscle. Even low grade can get to be invasive and standard protocol is a follow up TURB. At this point nobody knows how long you have had it so if it is T1, then err on the side of caution.

YOU are in charge. Learn all you can so you can be an active player (aka the driver) in your treatment. Ask them questions when they deviate from the standard of care called out in the NCCN guidelines.

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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11 years 6 months ago #43103 by Paul b
Replied by Paul b on topic To BCG or not?
Thank you for the information. I am leaning on holding off in the BCG to wait what happens in 90 days when my Uro goes back into the bladder.
Kind regards
Paul

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11 years 6 months ago - 11 years 6 months ago #43102 by Alan
Replied by Alan on topic To BCG or not?
www.bcgoncology.com/treatment/bcg.html

Dr. Lamm is like the godfather of treatments and has helped many on this board. I have copied and pasted part of his site: "BCG and Bladder Cancer
While BCG is recognized as the most effective treatment for superficial bladder cancer (bladder cancer not invading the muscular wall of the bladder), it is not necessarily best for every patient. BCG can on rare occasion produce serious side effects. Low grade tumors that grow as a polyp (mushroom shape) in the bladder and have no invasion at all are at low risk for progression. Even a small treatment risk, therefore, can be avoided. In these patients intravesical chemotherapy, typically using just a single instillation at the time of surgery, is recommended.
When tumors recur despite chemotherapy, when they are not low grade, and when they have superficial invasion or associated carcinoma in situ, BCG is generally indicated."

Indeed, low grade is often a "waiting and watching" event. The item that most of us would encourage is a second opinion which it appears you have done and with a specialist that evidently does mostly BC. Mine was high and basically had no option. If it was low grade my URO was ready to "wait and watch" like your second opinion. He studied under Dr. Lamm. Also, not alarm you but, every procedure has risks including BCG that can cause tuberculosis. Cystoscopes carry a small risk. In my case I have to have strong antibiotics after for a day due to stirring up some nasty germs. Hope I haven't confused the issue. Perhaps some posters with low grade can chime in.

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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11 years 6 months ago #43101 by Paul b
Replied by Paul b on topic To BCG or not?
Thank you for the replies. The report says " well differentiated, low grade " . My feeling is if the BCG will help, then do it. I know if I see a tumor in 3 months and I didn't dee the BCG I will feel bad, like I didn't do all I could. Hope that make sense.
Thanks again for your thoughts.

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11 years 6 months ago - 11 years 6 months ago #43100 by Alan
Replied by Alan on topic To BCG or not?
15MM while small still needs a second opinion to properly stage and grade the tumor. Many of these are often underscored by pathology. The grade is very important! Mike, I think you will concur as Paul didn't say what grade the tumor is. If it is high grade (2 or 3) you definetly need BCG. It will drastically reduce the chance of re-occurences and progression. If low grade (1), it is often wait and see every 3 months but, even then some recommend BCG. What grade was the path report?

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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