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Dysplasia following BCG
I was dx with a TA papillary tumor & CIS back in March, had TURB in April to remove tumors, follwed by 6 BCG treatments, completing in June. I suffered extremely severe inflammation from the BCG — bullous edema — swelling, bleeding of the bladder. I had another TURB back on Sep 7 and the biopsy results on Sep 14 plus urine cytology showed no malignant cells but the likely presence of “Dysplasia” — meaning “abnormal cells which may or may not be pre-cancerous”. The doc feels like the good news is that the inflammation and resulting dysplasia are actually keeping new cancer from forming. He said he may treat the inflammation with INF if it’s still bothersome later on.
Has anyone else experienced this sequence of events, and if so what was the eventual outcome? -
2 Replies
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Dan,
Thank you for taking the time to respond. I’ll have to admit being a bit daunted by the information you provided. The pathologist used the somewhat ambiguous term “favor dysplasia”, meaning I suppose that he was not quite positive about his findings. I will have a follow up cystoscopy on Nov 16. Suffice to say, no one is quite positive about what the irregular cells indicate. The statistics are, to say the least, a bit gloomy, but then who needs to have things sugar-coated. That’s why we have this forum. Thanks again. I will try to learn a bit more about the path report.
David
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There was a study done that compared the shapes of CIS, dysplasia, and normal urothelium cells. They concluded “Dysplasia, which is a somewhat ambiguous lesion, overlaps in its measurements with those of benign urothelium. The most useful morphologic parameter is the mean nuclear area of the 25% largest nuclei; CIS nuclei are approximately 5 times the size of lymphocytes, whereas normal urothelial nuclei are only 2 times the size of lymphocytes.”
My point is that the diagnosis of dysplasia can be subject to human interpretation (unless a fancy image analysis system is used). If it was me, I’d talk to the pathologist and get the details of his diagnosis. Your inclination for treatment may change depending if your dysplasia is more (or less) like normal cells.
Your initial diagnosis was CIS (high grade) plus papillary (grade ?). The eventual long term outcomes (15 years) from another study (the initial treatments for these patients who had high grade cancer were BCG and/or TURBT) showed that just over 50% of cancers progressed during the follow-up period, 36% required cystectomy for progression or refractory CIS, 34% of patients were dead of blc, and 21% developed upper tract cancer.
Of course, these results can’t predict specific outcomes, but they are pretty good guidelines.
Dan
[quote author=ddoyle link=topic=1194.msg8218#msg8218 date=1190390950]
I was dx with a TA papillary tumor & CIS back in March, had TURB in April to remove tumors, follwed by 6 BCG treatments, completing in June. I suffered extremely severe inflammation from the BCG — bullous edema — swelling, bleeding of the bladder. I had another TURB back on Sep 7 and the biopsy results on Sep 14 plus urine cytology showed no malignant cells but the likely presence of “Dysplasia” — meaning “abnormal cells which may or may not be pre-cancerous”. The doc feels like the good news is that the inflammation and resulting dysplasia are actually keeping new cancer from forming. He said he may treat the inflammation with INF if it’s still bothersome later on.
Has anyone else experienced this sequence of events, and if so what was the eventual outcome?
[/quote]
Dx 7/04, CIS + T1G3, Age 50
2 TURBTs
12 BCGs
Cystectomy 8/05 USC/Norris
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