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After BCG… recurrence
I am caretaker for my 83 year old uncle who made it through treatments for gastric lymphoma (last treatment in Feb 2014). He is being treated at a major cancer center in New York He was being monitored for gastric cancer, but they believe that it is just scar tissue from the lymphoma. He has made a remarkable recovery, gaining back 50lbs that he lost through disease and treatment. During follow up CT scans, a .5 cm spot appeared in May of 2014. They followed up and the spot grew to 1.8 x 1.3 cm in November. They setup a meeting with urologist and setup a TURBT that was completed in January 2015. Pathology report read:
– Left posterior bladder wall (in Hanks'(, TURB
– tumor type: non-invasive urothelial carcinoma
– histologic grade: high grade
– pattern of growth of the non-invasive component: papillary with prominent inverted growth pattern
– local invasion: no definite invasion is identified
– muscularis propria is not involvedFive weeks after TURBT he started BCG treatments and made it through all 6 treatments. Only on treatment number 4 did he feel any side effect (chills and nausea with no fever). We waited 5 weeks and had a cystoscopy (which was last week). There was a 3-4mm tumor near the bladder exit. We are setup for another TURBT on May 29. They had offered and appointment for this week but we didn’t think we could make all the pre-surgical appointments (im kicking myself for this because we probably could have made it work, I want this thing out as quick as possible. The urologist said it is probably a tumor, it sure appeared to be on the screen, I was with him during the procedure. He said a second course of BCG may be an option, and sometimes it takes that second course of BCG in order for it to work, has anyone had any success with a second course of BCG? I know he is older, but he is very resilient and is enjoying a good quality of life. I do not believe that a RC would be likely given his age, but who knows. Any input on what steps might be next or what we might look into? Waiting on the pathology is nerve wracking.
Thank you for reading this far, any input is appreciated.
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9 Replies
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BCG is generally considered to be more effective. Mitomycin is used either when someone has serious side effects and cannot take BCG or when BCG is unavailable.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
Just trying to get some opinions. I was able to locate a treatment center locally that has bcg. Would it be better to try mitomycin (MMC) or go in for a second round of bcg?
The pathology results from the TURBT came in, Non-Invasive Urothelial Carcinoma – High Grade Papillary. Local Invasion not identified. Muscularis propria is not identified. Benign prostatic tissue identified in a separate tissue fgragment.
So would I be correct in assuming this is not CIS (because it is papillary). The tumor/growth was rather small, the Dr. said 3-4mm at the bast of the bladder (bladder neck). Total sample was .5cm. I am wondering if the sample was from several parts of the bladder or just the tumor, there was some irritation in the wall of the bladder during cystoscopy and thickened bladder wall in CT. Will consult with the doctor, but wanted to understand a bit more as I formulate questions.
He is being treated at Sloan Kettering, the BCG shortage is effecting them, and a round of mitomycin is being recommended.
Thank you for the kind words. This isn’t my first time taking care of a loved one who is dealing with cancer. I guess I always have a few things I wish I did different.
Through the 5 recurrences, what has the treatments been? How many BCG’s? How many TURBT’s?
UTI’s are not uncommon when you are undergoing treatments such as BCG or having frequesnt exams. Several times during my BCG treatments we had to take a week off because of a UTI. I seriously doubt that anything that your family member had any relation to the infection.
Delaying a BCG treatment happens quite often…either due to UTI or to irritation from the BCG and it does not affect the results at all,.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
I felt like I was writing what I was reading here. My 82 year old family member has had the removal of a tumor and began treatments such as you wrote in your topi here. Well just today during treatment number 5 we learned he had a bit uti. This is so unbelievable because he looks great, been gardening,eats well and then this. Naturally it delays the end of this (apparent) round of six treatment deal.
I thought it unusual that the Urologist was looking at us strangely. That gave us a weird feeling. The only change from last week was the technician using the catheter to remove urine and instill the solution. Sanitary needs have been addressed with great care and detail. I wonder if wearing dark underwear or even those “Depends” could cause the bacteria to spread. What do you think. I hope no one minds me jumping on this topic here but I had no idea that there might be a long long line of instilations. I guess I should take every tuesday off from work. Is this unusual for instillations to work and then a uti appear? Thanks.
Yes! And sometimes, it takes more sets of the BCG treatments. Doug has had 5 reoccurences and has been cancer free for about 6 years now, so don’t give up…and waiting a few weeks for the surgery is okay. No more kicking yourself for that one, OK?
Anita (Doug’s caregiver)
Anita
Forum Moderator
Caregiver
As Sara Anne said a major cancer center should be able to figure whatever the next step should be as all cases have little nuances and differences. BCG often in a second round has interferon added, so that may be an option.
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.
So sorry to hear about your uncle’s recurrence. This is not uncommon. Since he tolerated BCG so well the last time, this would appear to be the best, if not the only, viable option at this point. If he is being treated at a place like MSK they should know what to do now.
Best of luck to him, and to you.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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