newly diagnosed by Karenb

Moonerj wrote:If the specimen is not adequate to contain muscularis, I would be worried that something could be missed.
The article states that the absence of muscularis is not an issue IF the cancer is non-invasive, but the stage (degree of invasion) is determined by looking at all the layers. The article implies that if there is abolutely no invasion of the lamina propria (Stage Ta) that it isn't necessary to see the muscularis layer, because the muscularis can't be invaded without invasion of the layer above it, the lamina propria. That is what is implied, but isn't stated. Unless the biopsy says "no invasion of the lamina propria", it cannot be staged without the muscularis layer.

I'm kind of concerned as to why the one kidney is not working and the stricture..something to address your second opinion doctor.
As your body is already compromised with Rheumatoid arthritis and i do not know what drugs you might be taking for that condition its hard to predict the interaction of BCG. BCG has certainly been known to activate arthritis in a certain percentage of those receiving it. Another good question to ask.
Pat

Having one functioning kidney should not be a problem for BCG treatments. The BCG instillation is in the bladder and does not typically get put in the ureters or kidneys unless there is spread into those areas (rare).

I'm not sure about arthritis but I think I recall people saying they had arthritis problems related to the BCG treatments.

You are not rambling and by getting 2nd opinions early in the process you are doing the right thing. First, you want to be sure you even have bladder cancer. Then, if so, what stage and grade. Finally, the treatment options specific to that. However, you are doing the right thing by asking the questions now so you have a sense for which direction to go based on what winds up being found.

If it is bladder cancer, then grade is important to determine BCG or not also. In some cases, they use mitomycin for low grade but as long as you're getting yourself to a bladder cancer center (once all confirmed) you should be in good hands.

Hope for the best, prepare for the worst, and be happy that typically things land somewhere in between.

I wish you the best of luck!

Mike

I'm back. Thanks for all the responses. Just to clarify, when I first went to urologist it was for UTI, referred by primary dr. Went for CT and IVP. Urol wanted to cystoscope due to appearance that right kidney wasn't functioning and a sticture in right ureter. Went for pre-op testing at hospital. Cysto was postpone cause my HCG level was slightly elevated, (I'm 3 yrs post menopausal...don't really think I'm pregnant, but what do I know) Went to gyno everything checked out there. She even consulted with a gyno/oncol to be sure nothing was missed. She had a pelvic ultrasound and transvaginal ultrasound done. The u/s showed a growth in my bladder. That's when I was finally able to cysto done.
Anyway, I have a or 2 question that hopefully someone here may have some info on.
If I am able to go the turbt and Bcg route, does anyone know if only having 1 functioning kidney have any effect on me being a condidate for the BCG.
I also have Rheumatoid arthritis which I have been dealing with for over 35 yrs. Does this have any bearing on being treated with BCG?
Sorry for the rambling.
The urol I'm scheduled to see Jan 8 received his urol/oncol training at University of Texas M. D. Anderson Cancer center in Houston, Texas.
I have also contacted Fox Chase Cancer Center in Philadelphia regarding 2nd opinion on the biopsy.

Well unless you're a seer which obvious the Johns Hopkins people are............
Bladder cancer staging and treatment relies heavily on tissue obtained at the time of transurethral resection of the bladder tumor (TURBT) where the tumor is excised endoscopically through a cystoscope. Treatment decisions are heavily based on the aggressiveness of the tumor (pathologic grade) and the layer of the bladder that is involved with the tumor (pathologic stage). It is imperative to obtain a sample of the muscle of the bladder at the base of the tumor in order to ascertain whether the tumor has invaded the muscular layer. The so-called ‘superficial’ or non-invasive bladder tumors arise from the mucosal (or the innermost) layer of the bladder wall and are usually completely resected during a TURBT. Tumors that have invaded the thin layer of connective tissue just deep to the mucosal layer called the lamina propria (stage T1), require special attention, since up to 30% may have evidence of muscle invasion on re-resection. If there is adequate muscle present in the pathology specimen to ascertain the absence of muscle invasion, these tumors can be treated with intravesical chemotherapy or immunotherapy. Treatment options for muscle-invasive bladder cancer differ significantly than their non-invasive counterparts. Radical cystectomy remains the gold standard of care for muscle invasive bladder cancer. Cystectomy provides accurate pathological staging of the primary bladder tumor and the regional lymph nodes, the best local (pelvic) disease control and long-term disease-free survival. In addition it provides accurate risk assessment and further identifies the need for adjuvant (additional) chemotherapy. Chemotherapy and/or radiation therapy is reserved for patients who are not candidates for surgery.
www.ohsu.edu/health/page.cfm?id=13583
Pat

apps.pathology.jhu.edu/blogs/bladder/?tag=muscularis-propria

"all 3 state no muscularis propria is present for evaluation"

They way I read this information from John Hopkins Patholgist, do you need musclaris propria when the tumors are noninvasive?

Jack