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Metastatic work up

12 years 5 months ago #844 by amy
Thanks Chris

Have a good day!


Alyssa

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12 years 5 months ago #842 by cta7978
Alyssa,

Stop worrying about your cancer matastisizing! The EORTC risk tables have your chance of progression (including metastatic cancer spread) at 0.2% (1 in 500) over 2 years and 0.8% (1 in 125) over 5 years.

Your cancer grade of 2/4 is probably equivalent to 1/3, but even is it is equivalent to 2/3 it does not appear to change your risk of progression, just recurrance rate (at least according to the risk table data).

Really, the EORTC statistics aren't perfect but when your looking at odds between 1 in 100 and 1 in 500, you probably have the same risk of getting killed in a car accident over 5 years.  Not enough risk to worry about and let it ruin your summer.

My understanding is they use the IVP or CT to view the upper tract because occasionally someone had a tumor in the ueretors or Kidney (since its all the same urinary system)... however in low grade tumors like yours it sounds like the standard care is to just do it once at diagnosis and not on follow ups.

Does no stromal invasion mean that the tumor is not in the lamina propria? I believe so, stroma means "connective tissue".

In case of a ta tumor is it biologically possible for it to spread into the blood or lymph system? Sounds like anything is possible, but statistically if you have a low grade single Ta I think your pretty safe. It could be that the only Ta tumors that ever recorded to have metastisized were actually T1 or t2 tumors that were misdiagnosed. Who knows the data isn't that specific or accurate.

Again (disclaimer), I am not a medical professional, so ask these questions to your doctor.





Chris A.
Diagnosed T1G3 - 3/01/06
37 yo, Seattle, WA

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12 years 5 months ago #841 by amy
Hi Chris

My tumor is a grade two of four but I am not sure if that qualifies as they are talking about anything higher than a grade one out of three. The pathologist also classified the two of four low grade. My tumor was also almost three centimeters (2.6 cm) but it was on a very thin stalk. Anyhow, I am assumming all that is required is uppertract imaging IVP or (CT urugraphy). Are both of theese scans only to image the upper tract only? Does no stromal invasion mean that the tumor is not in the lamina propria? In case of a ta tumor is it biologically possible for it to spread into the blood or lymph system?


Thanks
Alyssa

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12 years 5 months ago #838 by cta7978
Alyssa,

"To date, IVP has been the most common imaging modality used to evaluate the urothelium of the upper collecting system. More recently, a number of examiners have been using CT urography. Although some suggest an upper urinary tract imaging study such as these every one or two years, most believe that, in the absence of risk factors, urine cytologic evaluation and cystoscopy are sufficiently accurate.."

"Routine imaging follow-up is NOT indicated for patients with superficial TCC and no invasion of the lamina propria or additional risk factors. Patients with superficial TCC require careful observation and IVP or CT urography every 1-2 years IF any of the following risk factors for recurrent tumor are present: 1) tumor size greater than 3 cm or 10 grams, 2) higher than grade I tumor, or 3) adjacent or remote bladder mucosal changes or dysplasia or CIS. Additional imaging may be necessary if there are positive urine cytologic findings, hematuria, or abnormal cystoscopy"

Here are the National Guideline Clearinghouse guidlines for follow-up imaging of bladder carcinoma, yours would fall under the first table for Variant 1: Superficial TCC - no invasion or risk factors. The quotes above are from this link as well;

http://www.guideline.gov/summary/summary.aspx?doc_id=8310

 Enjoy your summer..

Chris A.
Diagnosed T1G3 - 3/01/06
37 yo, Seattle, WA

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12 years 5 months ago #837 by amy
Hi
I hope everyone is enjoying their summer. I have been trying to stay off this board and in the pool with my family. I saw my urologist today and he reassured me that the cancer I had could not have spread and that I did not need a metastatic work up. He said the only thing he needed to do was an IVP to visualize the upper tract. I had a papillary, low grade ( 2of 4) transitonal cell carcinoma with a prominent inverted growth pattern. No stromal invasion was seen. The tumor also had a very thin stalk. Is this agreed upon in the urologic community. Is IVP and cysto the standard for this type of tumor? It seems a lot of people are having cat scans. Are they in place of an IVP or are they to check for metastasis?

Thanks for the reply,
Alyssa

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