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5cm Tumor removed – Pathological report undefined. Seeing Urologist/oncologist?
Hello to all, any suggestions welcome.
Two weeks post CAT identified 5cm bladder papillary tumor. TURBT removal one week ago. Pathology report yesterday states “Low Grade Urothelia Neoplasm. Inverted Growth Pattern.” read that inverted growth is very unusual? No stage or grade identified. Referral to John Hopkins.
oncologist says pathology language likely low grade and stage – wait for more information. Seeing urologist two days for post op – what do I need to know and ask?
Bone scan today negative. However, feeling lymph tenderness and being told no PET scan is needed right now. Requesting MRI for suspicious abdominal organs liver cyst/spleenula – and told very low likelihood of organ spread.
Any thoughts ideas, information or suggestions welcome. I don’t really know what to ask, or even who does what, i.e. where does oncology start, and urology start. My primary care doctor is essential…acting hands off.
Any information greatly appreciated.
RG
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2 Replies
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Oncology imaging journal in 2002 says inverted form of urothelial tumor is rare, < 1%. Histopathologic features similar to those of normal transitional epithelium and epithelium of low-grade papillary tumors. Inverted Papillomas – the article
Inverted PapillomasInverted papillomas make up less than 1% of urothelial tumor of the urinary bladder, and they are usually seen in middle-aged patients (median age, 55 years). Their gross appearance is that of 1- to 2-cm smooth, nodular, or polypoid tumors that have histopathologic features similar to those of normal transitional epithelium and epithelium of low-grade papillary tumors. The majority of inverted papillomas are localized to the trigone. Most of them are less than 3 cm in size, but larger lesions can also occur. The main feature that distinguishes inverted papillomas from pappiloma carcinoma is the lack of dysuria and mitotic figures on cytology. Because of the presence of atypical cells in many cases, urine cytology is not helpful in determining the benign nature of inverted papillomas. These tumors are usually removed by TURBT , and diagnosis is established thereby. Recurrence of inverted papillomas is uncommon. A periodic follow-up of the bladder is suggested because an association between transitional cell cancers and inverted papillomas has been reported.
https://www.ncbi.nlm.nih.gov/books/NBK537218/
Boundary between oncologist and urologist
A very good question. I think it depends upon hospitals. Some hospitals may involved oncologist in early stage.
I live in Canada and I go to a local hospital. My urologist is a urologic oncologist. He is a University of British Columbia trained Urological Surgeon who completed a 3-year urologic oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York City. I have noticed that in case of bladder cancer, oncologist is involved for systemic treatment, i.e. chemotherapy, radiation therapy and immunotherapy. But, treatment confined local to bladder seems to be dealt by a urologist, i.e. intravesical BCG, intravesical chemotherapy, TURBT, cystectomy, cystoscopy.
Questions to ask.
AUA guidelines classifies low grade as intermediate risk if low grade tumor is > 3 cm. The treatment for intermediate risk non muscle invasive bladder cancer (urothelial type) is either 1 year intravesical chemotherapy or 1 year intravesical BCG. So, you may want to ask what kind of treatment you will be receiving. Low grade non inverted tumor has very high recurrence, but according to a write up by University of Michigan, inverted urothelial papilloma has <5% of recurrence. So, it is possible that you may be put on just surveillance by cystoscopy. Please note that 90% of non-muscle invasive bladder cancer is urothelial type. Other 10% consists of non-urothelial variant types. Because the pathology report did not say your tumor is one of variant, eg. micropapillary, adenocarcinoma, squamous carcinoma, your must be urothelial type.
best
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Welcome RG,
First, the “low grade” path report is obviously better than the high grade. The referral to John Hopkins is a good move as second opinions and an “expert” hospital on many cancers is a key. Do use them, they are excellent. Be prepared for a second TURB to confirm your first DX as that is normal. You need to know what stage you are at. Ta, 1,2,3,4 is a key to the next step and I have learned NOT to second anything until all the pieces are in.
It also looks like the normal protocols are being followed. I am attaching a Q&A I found some years ago. Just use the questions that apply and keep asking as you go .Some involve a cystectomy which very likely will not affect you. [attachment=391]
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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