-
Nervous Dad!
I was recently diagnosed ( at an office cysto) with a 1cm bladder tumor that appears to have fine papillary features. It looks like it is most likely low-grade TCC. I am 45, never smoked, exercise and am in good health. I am scheduled for a cysto with fulguration and biopsy next week. I just wanted to check if this is the correct 1st step treatment. This was a surprise to me but I am glad I had it checked after I noticed blood in my urine following a jog. I have two young children and am nervous! Many thanks for any advice and help.
-
10 Replies
-
Hi Greg,
About the TURB issues, transuretheral resection of bladder, fulguration is pretty common to keep the resected tissue from bleeding. It doesn’t ruin the specimen for pathology. So, your current plan of biopsy and fulguration sounds familiar to me, my sister had the same, she goes to Sloan, had a 3cm papillary tumor. She never received Mito, and most people with TaG1 tumors don’t need it unless they continue to recur.Your doctor is up on the latest guidelines but you still have the choice to not get the dose of mitomycin, see what the results are, see if you recur within the next year or two…my sister had the same grade and stage recur, never had any treatments aside from TUR, and they haven’t recurred for thse past 7 yrs or so.
Lasered tumors will give you that situation where biopsies are wrecked, but that is reserved for people who have recurrent, low grade TA tumors that dont’ need biopsies everytime they are removed.
Good luck, the fact it’s so small and looks like an obvious papillary is a very good sign, all things being relative.
Wendy
-
I will be getting a dose of Mitomycin with my procedure on Wednesday. Is that typical? I read some threads and there seems to be some controversy. Just wondering if I should ask my uro to skip that part. Thanks,
Gregg (shaz)
-
[quote author=shaz link=topic=1061.msg6898#msg6898 date=1185410967]
What’s the difference between a TUR and a cysto with fulguration? [/quote]
If I remember correctly, TURB stands for TransUrethral Resection & Biopsy… which is, of course, done through a cystoscope. If the tumor is fulgurated (burned) to remove it, there is nothing left to biopsy; however, if the electrocautery is used to remove the tumor and at the same time fulgurate the tissue underneath to stop bleeding, than a cysto with fulguration would be one method to do a TURB.
-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant 5/2014
Pediatrician
Hi Rosemary, Patricia and Shaz,
There are urologists who take a biopsy and then fulgerate right in the office during the cystoscopy. Not many are equipped to do that but it sure saves the patient lots of time and money. I was in touch with a blc patient named Pat when on the ACOR email list whose urologist did it that way. She said it just felt like a “pinch” when he took a biospy sample. I have since been in touch with others whose doctors do that. All were in private practice and not under the guidelines or protocol of major cancer hospitlas. I have now found a urology group in Norfolk who can do procudures in the office right at cystscopy. I like that so much more than having to reschedule, go through pre-op, be put asleep to have a suspicious growth removed. All biospies, regardless of it being done in a hospital operating room setting or in the office are sent to pathology. It is more ideal if a cauterization or fulgeration is done after the TURB but it my case the fulgeration could not be done because of the location of the tumor and threat of scarring the area and closing off the opening to the left ureter orifice. Rosie
Thanks Pat. A biopsy is inlcuded in my procedure next week.
Gregg
Well a cysto with fulgeration is just going in there and lasering out the tumor without taking a biopsy for pathology……..A TUR is a resectioning of the tumor to send to pathology which is definately what you need to have done. It sounds to me like his plan is to do the TUR and then lasering it. He’s assuming that the naked eye is reliable….
In my case since there was invasion into the muscle there was no fulgeration done.
Was that clear as mud? Pat
Shaz,
I don’t know the PRECISE answer to that question.
My doctor did a TURB and he also “cauterized” the area where he removed the tumor. I always assumed that this was fulguration.
Anybody?
Rosemary
Rosemary
Age – 55
T1 G3 – Tumor free 2 yrs 3 months
Dx January 2006
Thanks Pat and Rosemary. I live in Milwaukee, WI. I think I have a good URO but you never know. I checked with my primary doc and he said he would feel very comfortable with my URO. There is a teaching hospital here with some good docs. My thought was to get this done and find out exactly what I have. If needed, If it’s T1 or higher, I would add seek another opinion and add some more members to my team. My procedure is scheduled for 8/1
What’s the difference between a TUR and a cysto with fulguration? Many thanks for your kind words and help
Shaz..in what part of the country are you? Has your uro had a lot of experience with bladder tumors and you want to make sure you have a top notch pathologist.
This type of thing always comes out of the blue with blood in the urine and absolutely no indication health wise that a thing was wrong. I will just relate my experience ….i was in such a panic with gross hematura that i went with the first uro recommended. The cysto i had made it look like it was nothing…a tiny singular papillary tumor…..NOT….it was Stage 2 T2.. and muscle invasive. .After getting my wits about me i made the decision to go to Memorial Sloan a top facility for bladder cancer and to Dr. Harry Herr. They got me in within a week of calling and Dr. Herr insisted on a second TURB. He went in and found the first Uro did not get the margins which could have been really big trouble. I’m not saying this to alarm you….i just want to make sure you are in extremely capable hands and its always prudent to get that second opinion anyway. As for the Mitomycin issue….Memorial will not use it on a first turb as you don’t know how much you will have to scrape plus it may not be necessary. I wish you the very best………Pat
Dear Dad,
As far as I know, this is the ONLY treatment for 1st time occurrance. You really need to get that tumor out of you and have it biopsied. Low grade TCC is the best dx to hope for, but I personally wouldn’t want to rely on a dr’s naked eye to draw that conclusion.
As you probably know, the specimen will be sent to a Patholgist for Stage and Grade.
The path report will tell you if the tumor has invaded any of the bladder layers and will also tell the grade of progression.You may or may not be receiving a dose of Mitomycin C after your TURB. You might want to ask your Urologist if there is any plan for this chemo treatment. Some doctors will use the Mitomycin and some will not.
I was 53 when diagnosed in 2006, never smoked and was in the finest pitch of health. I had a follow up TURB 6 weeks after the initial TURB to check for residual tumor, which the doctor did find. I received a dose of Mitomycin C at that time also.
If you have any further questions, please feel free to ask and we will be happy to help you in any way we can.
I know you are nervous. I was very nervous, too..
Your new BC friend,
Rosemary
Rosemary
Age – 55
T1 G3 – Tumor free 2 yrs 3 months
Dx January 2006Sign In to reply.
