Mom just had TURB and I have questions

17 years 3 weeks ago #4649 by Rosie
Replied by Rosie on topic Mom just had TURB and I have questions
Rosemary and Kim, I think verification of our pathology report and a running knowledge of our type grade and stage is most important to us personally and also those others on this forum who are seeking advice based on our knowledge and experience. In this case, I wanted to clarify your type, grade and stage, Rosemary because Kim was probing and very concerned about the necessity of a re-turb for her mother. She was concerned if it was important to do so. When you said "-- Kim, As you can see, I also had a Re-TUR six weeks after the first, even though I "presented" initially with low grade disease" - - which indicated you went from a TA grade 1 the lowerst possible to a T1 grade 3 in pathology from a re-turb done 6 weeksk later. It may have put an anxious red flag out to Kim and others reading that statement rather than the reader questioning, as I did the validity of the pathlogy reports. This is the first time I heard you tell of a 3rd biopsy Rosemary. I suggest you get the written pathology report from all 3 biospies and if they look very contradictory such as the terrific agreesivness and increase indicated in your first TURB to the second one done six weeks later, you should question the doctor to clarify exactly your type, grade and stage. I am also concerned with you possibly being undertreated or overtreated by you having such confusing information. There are many scares floating around in the cancer community through hearsay, third person reports, improper write ups, under or overstated pathology reports that can be perpetuated unless we can verify or discount. I went through 2 years of feeling overly scared about my condion becuase of those I dealt with the most in the medical arena and/or patients were overly dramatic, cautious and warning of possible dire consequences or outcomes. That is why clarification of what type, stage and grade needs to be part of all cancer discussions. Rosie

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17 years 3 weeks ago #4645 by Rosemary
Replied by Rosemary on topic Mom just had TURB and I have questions
Rosie,

Just to say, that I think that is probably very good advice to all of us. I actually do not have the paths from my first two TUR's. I only have a path from the 3rd biopsy.

I think I will work on getting that information.

Thanks for the suggestion.

Your BC friend,
Rosemary

Rosemary
Age - 55
T1 G3 - Tumor free 2 yrs 3 months
Dx January 2006

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17 years 3 weeks ago #4641 by Rosie
Replied by Rosie on topic Mom just had TURB and I have questions
Rosemary, it seems the write up from doctors office has confusion and mistakes on it. Don't go by what is written by the officie personnel at the urologists office. They often make mistakes. I have caught several write up mistakes in the doctors report. One said is was near my right ureter orifice when in fact it was at my left ureter orifice. I state this as a warning to all. If you see inconsistencies in a doctor's report have it clarified because it will continue to follow you. It is best to read the pathology report and the hospital report of the actual TURB. For instance where did the statment " She now presents for evaluation of her T1 focally high-grade urothelial carcinoma." Where did the T1 assumsion come in? So, Kim, read the pathology report, the doctors report, the hospital report and compare of consistencies and/or inconsistencies.

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17 years 4 weeks ago #4632 by Rosemary
Replied by Rosemary on topic Mom just had TURB and I have questions
Just to sort out some confusion about my pathology, this is taken directly from Dr. Pruthi's notes (UNC-Chapel Hill) that my doctor has his own copy of....evidently my Doc has got a lot of notes on me, and had trouble reading the previous Doctor's notes.

Kim, As you can see, I also had a Re-TUR six weeks after the first, even though I "presented"  initially with low grade disease.  Why my doctor made this decision to Re-TUR  and gave me Mitomycin, I cannot say.  But, I am glad that he did.  

My 2nd TUR specimen went to two pathologists because the first pathologist wanted a second opinion.  I don't know if that means that he wasn't sure of what he was looking at, or what.   My point being, Kim, (and you just hate to QUESTION a Sloan Doctor about what he is doing, because that is why you go to him)....HOW DOES HE KNOW THERE IS NO RESIDUAL TUMOR THAT WOULD CHANGE THE STAGE AND GRADE OF HER DISEASE?  I'm just basing this question on what happened with me.

You know sometimes, it is so hard to get your doctors to talk to you like you are an intelligent human being, because they just don't really think of us that way.   (Am I imagining this?)

I don't know if all of this helps you.  My wish for you is that you feel comfortable with the care that you are receiving for your Mother.  If her doctor could just explain things a little better....

Respectfully,
Rosemary

Rosemary
Age - 55
T1 G3 - Tumor free 2 yrs 3 months
Dx January 2006

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17 years 4 weeks ago #4627 by klau1973
Replied by klau1973 on topic Mom just had TURB and I have questions
Well, I spoke with the nurse at Sloan today. She was unable to tell me the T stage. She said that it was not staged in the path report (which I know because we have a hard copy of the report) and she reiterated that it is superficial high grade. I am really upset that they can't tell us the stage and grade. I am assuming Ta, G3 but I hate to assume anything. Why would this be absent from the path report? Am I fixating on this too much?

Also, she said no mitomycin was administered, but couldn't explain why. She simply said, "He doesn't always do that." I am thinking that because his initial impression was low grade he didn't do it, but now we find out it's high grade and I'm thinking it should have been done, or perhaps he didn't do it because it was so superficial. I don't know! I hate that I can't get direct answers to these questions. We convinced my mom to go to Sloan because we thought they would answer our questions better than the first uro she saw who took issue with us asking questions. I am getting very frustrated. Plus, the CT scan shows some density in the area of her uterus (keep in mind that she had a hystorectomy 30 years ago), but the doc doesn't know what it is and he is not ordering any further test to determine what it is. He said he's not worried about it. I guess it could be scar tissue, but no one has said that and I hate guessing at these things.

The only good news I have to report is that my mom is in very good spirits. She was so relieved about keeping her bladder. This is the best I have heard her in weeks, so that makes me feel good.

I'd appreciate anyone's thought about all this.

Kim

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17 years 4 weeks ago #4622 by Rosie
Replied by Rosie on topic Mom just had TURB and I have questions
Kim,

I know there isn't complete agreement on re-turb or not. I did not have an immediate returb but went right into 6 treatments of BCG - 1 a week and then a scope. At the first scope post TURB a small "spot" was seen. The doctor talked about another TURB but I asked if we could do more BCG to see if that would take care of it. We did 3 more treatments and the spot was gone. It may not have even been a recur. Often times over eager doctors TURB or cauterize on nothing spots that are actually inflammation. I don't like being put through constant "surgeries." I presently do long term watchful waiting when a new "growth appears" rather than immediate TURB. I did watchful waiting for a year and a half on one recur tumor before having it removed. Of course, I did have urine cytology done each time to be sure it wasn't high grade. When I had my first TURB 7 years ago the practice of instillation of Mitomycin for papillary after TURB was not the protocol. Rosemary, I would be very confused as how to proceed with the contradictory pathology reports given to you particularly since your present doctor thinks it a much lessor type and grade. Doesn't it prey on your mind? It certainly did me when the first pathology report indicated a T1 grade 2 but was later downgraded to a TA grade 2. Recurrences came up as TA grade 1. So you see Kim, sometimes the type and grade are downsized as well as some being upgraded.

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