Superficial BC vs. Metastatic BC

My tumours never got beyond being Ta G3 - although I only had one G3 and the rest were G2. The CIS was what concerned me in combination with the G3. The other factor was the number. I probably had 30 or 40 removed over the years. I also reasoned that it was likely that I'd have the cystectomy eventually anyway so I may as well have it when it has an optimum chance of working. It said "elective" on my consent form which I was strangely proud of as it made me feel like I was back in control!

Tim

Darn did I learn alot from this thread. I have no choice Stage2 G3 so my bladder is coming out. But I can see where others with say Ta or T1 might wanna take chance with follow ups so as not to lose bladder. But I did know this even before I was dx with BC from others with different kinds of cancers. Cancer is a very tricky disease and anything is possible as we all know it attacks our immunse systems and we are all different in that respect. Sorta like some folks can handle more pain then others to use as an analogy. I just know this cancer is not a disease I am going to gamble with no matter what. Thanks Wendy that was a great heads up post and made me think. Just like they told me no cancer in lympnodes or other organs like you said from what they can see.Thanks, Joe

Hi Rosemary,

I surely can relate to how things become a blur...my first two years into treatment are a total blur.

You asked:
"Why would patients with T1 superficial disease have a cystectomy? "
That would be either personal choice or the doctor's advice. Sometimes even people with Ta, high grade blc end up wishing they'd had a cystectomy sooner, and in fact ta, G3 should be considered in the same category as T1,G3. You read in retro studies how many people with Ta, T1,2,3 and 4 were in the studies and of course the stats end up showing the earlier the cystectomy is performed, the better the long term survival. We're talking about high grade disease and CIS, not papillary tumors.

" Would "no apparent invasion" mean no apparent invasion of the lymph nodes?"

Not necessarily, because cystoscopy can miss tumors and CIS a scaryingly large amount of the time, "no apparent invasion.." means to the best of the ability, with the tools at hand, there is no apparent invasion of the bladder lining into the muscle. CIS is famous for being invisible, beneath the bladder lining. The results of the new blue-light cystoscopy systems make me feel it's unethical not to be using this technique. ( blcwebcafe.org/hexvix.asp ) It makes CIS light up like a psychedelic mushroom in a 60's black light poster.

Wishing you a good day,
Wendy

Thanks Chris and Wendy,

You both cleared up a lot of territory for me.

After reading your reply, Wendy, I now understand why my doctor sent me packing to the Urological Surgeon after my 2nd path reported T1 G3 disease.

I really wish, now that a year has passed, that I had thought to keep a notebook of all the conversations with my doctor from around that time.  (Initial diagnosis).  It's amazing how many tidbits of information become a blur.  

For instance, when the Dr. received my path from the re-TUR (2nd path), the pathologists themselves asked for a 2nd opinion.  He told me that because of the way the tumor was "bulging" into the lamina propria, there was a possiblility of upping the Stage and Grade.  He said it could also mean.....(? I can't remember what he said).   When the 2nd path came back, they  decided that it was a higher stage and grade than previously supposed.  (From Ta G1 to T1 G3 in just 6 weeks, a mercurial rise, I think).

I have taken Rosie's advice and have requested a copy of my first 2 paths.  Hopefully, this will answer some more of the blurrier details for me.

After all, there is a great difference in methods of approach between Ta G1 and T1 G3.

I'm sort of rambling here.  I'm off to work.  I should hopefully get those path reports today.  Maybe there will be something of interest to note as to WHY my Stage and Grade jumped up so quickly.

Thanks for listening.  And thanks for the input.

Rosemary

Hi Rosemary and Chris,

I'm sorry to say that even grade 1, Ta tumors may sometimes, rarely-less than 5% of the time- recur as more aggressive tumors or even metastasize. I have met a few people who have started out with ta, g1 tumors and who are no longer with us. This is the reason a person with a ta, G1 tumors must continue with follow up forever.

There is a very rare type of 'tumor' known as polyps or papilloma, and these are almost certainly not cancerous, while Ta, g1 tumors are of abnormal cell growth:

"Both papilloma and papillary urothelial neoplasm of low malignant potential may develop recurrent or new papillary lesions but only the latter may be associated with invasion or metastases in rare cases. The study by Magi-Galluzzi and Epstein disclosed the clinical behavior of 34 de novo papillomas. The follow-up showed that 6 patients had recurrent disease but none progression to either lamina propria (T1) or muscularis propria (T2) invasion. This paper confirms that papilloma and papillary neoplasm of low malignant potential should be considered separately. The urologist should follow-up patients with papilloma but because they have a low incidence of recurrence and rarely progress to develop noninvasive urothelial carcinoma, it seems reasonable to avoid labeling these patients as having cancer."

By the way I got that statistic from a number of different sources, and have read it time and time again, sometimes it's a bit lower, 3%. I'd say 10% rate of progression for ta, g1 tumors is the highest number I've seen in an article about bladder cancer.

Wim Oosterlinck is very famous in Europe and is the head of the genito-urinary oncology division of the European Org. of Cancer Research and Treatments, head author of all guidelines for blc in Europe and someone I've quoted extensively on the webcafe site.
blcwebcafe.org/superficialblca.asp
Rosemary, I think that article you gave the link to is from Sept. '03 - the hint is in the link.

T1 tumors are dangerous because they are a form of cancer that has already invaded, different from Ta, g1 tumors in that respect. If a person has a combination of T1 and CIS, bladder removal is the safest bet.

Take care,
Wendy

That looks like a pretty well written article by the way.