maybe this will help www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_bladder_cancer_staged_44.asp
At any rate its always a good idea to have a second pathologist look at the slides.
personally when i took mine to MSK they took one look and tossed them and recommended a second TURB ...the samples were not good enough.
This looks like a simple case with a good prognosis but to be sure have the experts give a second opinion.
My opinion is to have the bladder cancer specialists (MD Anderson) confirm the diagnosis and recheck that pathology and give her a treatment recommendation.
If that treatment plan is BCG or even Mitomycin, then I'd suggest having the local urologist administer it so she could stay close to home.
MD Anderson could very well suggest a "watchful waiting" which is regular cystoscopic exams and TURBs.
I know some people on this site have been treated with BCG for low grade Ta tumors and others have not. I think that's based on the doctor that one sees. I think an MD Anderson specialist would probably be the best one to make that treatment plan recommendation (once they confirm diagnosis). They may even want to do a cysto and/or reTURB just to see for sure.
From my understanding, the fact of having tumor recurrence, even though low-grade, could reasonably warrant starting on the BCG. I had a similar concern about the need for BCG, in that I had recurrence of only low-grade tumors, and that was after two years (not the short 6 months). However, my urologist recommended it, so I started BCG back in 2008, and am now on 6-month maintenance dosing.
And, based on my limited knowledge, the "PUNLMP" designation for tumors is not so common any more. If I had to guess, I'd suspect that the initial tumor and recurrence were both the same type, i.e. TA, grade 1 (at least as it sounds from the reports you've typed in).
Small TA Grade 1, May-06; recur (2 tiny), same, June-08; TURBTs both times. BCG begun July-08, dosage to 1/3rd May-10, completed treatment December-11. All clear since 2008.
Pat: when it says "low malignant potential" does that mean it is not currently malignant and that the potential for becoming malignant is low or does it mean that it is malignant but not likely to grow into something much more serious (i.e., become invasive, matastasize, etc.)?
On the BCG issue, considering a tumor came back w/i 6 months (low grade or not) would that suggest that BCG might be appropriate?