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confused on diagnosis

4 years 5 months ago #51098 by sara.anne
Both docs are talking about exactly the same procedure. Under general anesthesia, the urologist carefully examines the bladder and removes any obvious tumors as well as samples of other areas of the bladder that look suspicious. These are sent out to a path lab for analysis. Once these results are back, it is not unusual for a urologist to do a second TURB a month or so later. If he goes in a second time (and this is only done if he feels there is a good reason) the urologist has a much better idea of where the problem areas are and can take more specific samples.

In my case, the first TURB samples came back as "papillary urothelial carcinoma and there were areas of "non-specific" dysplasia. When my urologist went in a second time, he concentrated on the areas of "non-specific dysplasia" and took lots more samples. The diagnosis the second time was that these were CIS...a high grade form of bladder cancer needing immediate treatment. I am very fortunate that he did the second TURB.

As I mentioned above, both of the doctors your husband has seen are recommending the exact same procedure...just using slightly different terms to describe it.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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4 years 5 months ago #51097 by Rita C
Hi Sara,

THank you for responding back...I appreciate all you said. Yes, we definitely won/t know anything until it is biopsied. Until then it is the waiting game...Yes, the second opinion doctor will be doing the surgery...He was the one that called it a "Conservative surgery." He said they can always go back in and take more if needed. I'm not sure how I feel about that or if that is how it is normally done....as the first doctor called it "Trimming." They'd go in and trim and test, trim and test...sooo, I didn't know if the pathologist was on call and looked at it right then and there to see if more needed to be trimmed or they put him under anesthesia again to do. I messaged the doctor who will be doing his surgery last night and that was one of my questions.

Thank you,
Concerned wife...

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4 years 5 months ago #51095 by sara.anne
Your husband will not really know what is going on until after the biopsy/surgery (called a TURB for transurethral resection of the bladder) which is done under general anesthesia. Biopsies are not normally done during cystoscopy, where the urologist is just looking visually at the inside of the bladder since without anesthesia OUCH!! During the TURB samples are taken and sent to a pathologist for microscopic analysis. Only when the report comes back, and this can take a week or so,can a definitive diagnosis be made. Urologists have a lot of experience, and can make educated guesses at what they see during cystoscopy, but they can be fooled.

Transitional cell, or urothelial cell carcinoma is the most common type of bladder cancer and is highly treatable if discovered early.

I got a little confused as to where the TURB is being done? At the second opinion urologist? So far, I wouldn't say that one or the other is being "conservative." They both would be doing the biopsy/TURB. One told you he "thinks" it is cancer, the other says he "thinks" it isn't. Some doctors NEVER say that they "think" something is cancer even if they really do, since patients get very upset when they hear the "c" word. In any case, until the biopsy results are back NO ONE KNOWS FOR SURE.

In addition to the diagnosis of cancer or not, the biopsy will tell the urologist how advanced the cancer, if it is there, might be and then a treatment plan will be proposed.

Your husband should go with the doctor in whom he has the greatest confidence.

Best of luck to you both

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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4 years 5 months ago - 4 years 5 months ago #51093 by Rita C
HI, I am new to this List and I am very thankful that I have found this. On 4/18 my husband (age 55 yo) and I went to his Urologist to get the results from his CT scan he had two weeks prior to that. He initially went to the Urologist to see if he was getting kidney stones back again as he had them in 2002. He said it was feeling "weird" when he peed and he thought he saw blood in his urine---he's color blind, so it isn't always easy to see the right colors. Dr. found blood in urine, and with history of kidney stones, ordered a CT scan.
so, now we are in the office to discuss the CT scan and dr. informs us that my husband has a bladder tumor...THe Radiologist said it was a tumor a little greater then 3 cm and probably transitional Cell Carcinoma....he did a cystoscopy right then, I saw the tumor, no biopsy done, there was a calculi in the tumor which he showed us, no pictures were done either. Surgery is scheduled for 5/13/16. Husband and I decided to get a second opinion and we found another urologist in a bigger town....

We went to doctor last Thursday 4/28/16 and he was matter of fact...showed us the CT Scan, said it probably was NOT a tumor, that more then likely inflammation which formed from the bladder stone irritating the tissue around it. I told him I saw the stone and the tumor and would he like me to describe it...he said, "No, I pretty well know what it looks like." I felt that was arrogant....I asked if he ever saw this before with the stone causing inflammation he said "NO." I called the original urologists office last Friday (A day after the second opinion) and told his nurse that we were talking to someone who had inflammation in their bladder and could this perhaps be that. His nurse so no way, Rita, I saw the tumor and it had all the attributes of a tumor. We will get the biopsy done and know for sure.

SOOOOO...my question, has anyone ever heard of the bladder stone causing inflammation. My husband is scheduled for removal of the stone and also a biopsy of the tissue. How concerned should we be...I haven't told my husband about my call to the office...he doesn't want to hear it and doesn't want to be stressed about it right now. He has major things coming down at work this week too.

Any advice you can give me, I sure would appreciate it...Any special questions I should ask this 2 doctor I will do. My husband wants him to do the surgery since he can get us in a lot sooner and is being very conservative. Could he be too conservative. Doc said he'd rather do a ittle bit at a time and then can go back in if he needs to. Please HELP!!Thank you sooo much

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