Just diagnosed: cystoscopy + biopsy recommended

2 years 10 months ago #55449 by fingerscrossed
Just diagnosed: cystoscopy + biopsy recommended was created by fingerscrossed
Hello - after seeing blood in my urine, an ultrasound and a CT scan revealed a 1.7 x 1.0 x 1.7cm mass in my bladder. The ER docs that treated me recommended that the next step be a cystoscopy that includes a biopsy of the mass. This made a lot of sense to me, but I'm being told (I'm being treated at Stanford) that the normal process is just the cystoscopy; further follow up will be planned later. I've learned that at least part of the reason is that cystoscopies alone are outpatient procedures, if a biopsy is also done, it requires a surgical facility.

Thanks for any advice - should I hold out to try to get both done together as my ER docs recommended? In addition to saving time, I don't know what's to be gained by a cystoscopy alone if a biopsy almost certainly has to follow. I also don't know if a cystoscopy can confirm the stage of my cancer, which is obviously very important.

Thanks.

Please Log in or Create an account to join the conversation.

2 years 10 months ago - 2 years 10 months ago #55450 by Alan
Welcome,

First, you ask very good questions. CT scan, cytology and cystoscopes are normal protocols. Add Stanford and you are in great hands. Yes, if the scan shows a mass it is curious why more of us don't go straight to the TURB surgery (transurethral resection of the bladder) and get a biopsy. It might be simply that most doctors try to do the least invasive tests and treatment if possible. With a mass seen it does beg your question and there might be a reason. It could be just a "mapping" and preparation of what the doc wants to do next OR, maybe one does the scopes but not the biopsy. One thing for sure, one does not really know what we are dealing without a biopsy. Waiting is the worst part however, keep in mind this is treatable and beatable. Keep posting and others will chime in.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

Please Log in or Create an account to join the conversation.

2 years 10 months ago #55451 by sara.anne
Replied by sara.anne on topic Just diagnosed: cystoscopy + biopsy recommended
The cystoscopy is done so that the urologist can get an "up close" look at the situation. It is possible that it is not cancer but some other type of obstruction. If the urologist does feel that it is cancer, he/she will have a much better idea of how to approach the TURB. Since cystoscopy is a barely invasive office procedure ...takes about 10 minutes, and a TURB is surgery done under general anesthesia (usually as an outpatient) it makes a lot of sense to take advantage of the information that the cystoscopy provides. It was very good that the ER sent you to a urologist, but I am sure that they left the entire explanation of the expected procedures up to the urologist. What you are having is exactly according to the current "standard of care."

I would second Alan's comment about Stanford. That is one of the best places in the US to go for suspected bladder cancer. You are in excellent hands!!

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

Please Log in or Create an account to join the conversation.

2 years 10 months ago #55452 by fingerscrossed
Replied by fingerscrossed on topic Just diagnosed: cystoscopy + biopsy recommended
Thank you Sara and Tom for your quick replies, I really appreciate them.

Sara - just confirming that - contrary to what my ER docs said and maybe also to Tom's thought - you think it's actually best to do the cystoscopy before the biopsy/TURB? In other words, if both were done together, would the TURB potentially be less comprehensive and effective?

By the way, my uro/onco doc's PA told me this morning that stage probably can't be determined until the biopsy is done.

Thanks again.

Please Log in or Create an account to join the conversation.

2 years 10 months ago #55453 by sara.anne
Replied by sara.anne on topic Just diagnosed: cystoscopy + biopsy recommended
Absolutely. It would be inappropriate for the urologist to do surgery without doing an examination (cystoscopy) first.

And the PA was correct. After the TURB the urologist will have a very good idea of where the tumors were and what they looked like. However, it is only after the pathology report comes back (and this may take up to a week) will the exact diagnosis be know. There is a lot of "hurry up and wait" in medicine!!

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

Please Log in or Create an account to join the conversation.

2 years 10 months ago #55454 by fingerscrossed
Replied by fingerscrossed on topic Just diagnosed: cystoscopy + biopsy recommended
Thank you Sara. Your and Tom's fast replies are super appreciated, as I'm planning this out now with docs and PAs (as you can tell :)!

Please Log in or Create an account to join the conversation.

Moderators: Cynthiaeddieksara.anne