CIS after papillary tumor

6 months 3 weeks ago - 6 months 3 weeks ago #61338 by joea73
Replied by joea73 on topic CIS after papillary tumor
Your pathology report says TaG1.   G1,G2,G3  are a bit older classification, still in England it is the recommended grading system.
WHO changed in 2004 to papillary urothelial neoplasm of low malignant potential (PUNLMP), and LG and HG carcinoma.    Your pathology is TaG1 and papillary type, which rise into lumen of the bladder.  Ta means the tumor has not penetrated through the basement layer.  G1 means either it was PUNLMP or LG.  TaLG is stratified as low risk.   Statistically, TaLG has recurrence ( rise of a tumor or tumors, at the same place or difference place of the bladder) about 30-60% in 5 years.  But progression to HG or CIS is rare (5-15% depending on studies).  CIS looks HG under microscope, but had not penetrated through the basement layer.   Now a days, they can analyze entire DNA sequence of the tumor rather in expensive way.  So, they have done DNA analysis for muscle invasive tumor and non muscle invasive tumors.  The profile of gene mutations between muscle invasive and high grade/cis are similar.  That is why we need aggressive treatment such as by BCG.  But, the profile of gene mutations for LG is different from the profile of HG.  The prominent differences are that LG tumor has the mutation in fiber growth factor receptor genes (FGFR) , and HG or muscle invasive has mutation in TP 53 gene which is considered as tumor suppressor gene.  So, often LG and HG are mentioned as different cancer.  So, it makes sense that TaLG or TaG1 are treated with TURBT only followed by regular cystoscopy.    I agree bluelight helps the confidence level of cystoscopy, but I think they are used by large hospitals in the US and not much in England I guess.   I understand your having anxiety especially they found something in cystoscope.  I get anxious for annual cystoscopy too.   But, odds are in favor for you to have LG again if it happens to be tumor.   best luck

WHO grading

......G1...........G2............G3........
PUN........LG.........-HG.............

Lining of bladder

OOOOOOOOOOOOO  Superficial layer
00000000000000000
00000000000000000    Intermediate layer               Ta region
00000000000000000   
oooooooooooooooo    Basement (Basal) layer

Connective Tissue (Lamina Propria)     T1 region

Muscle Tissue   T2,T3  region
Fat

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6 months 3 weeks ago #61335 by dtat60
Replied by dtat60 on topic CIS after papillary tumor
Is it hard to see CIS on a cysto?

My Urologist did a followup TURBT with blue light cystoscopy  a couple of months after my initial TURBT and discovered CIS. He said he was glad he did because he found a "small" patch on the upper bladder that he probably would have missed. In fact he said he had to have an assistant push down on my bladder during the procedure in order to remove it. I had an infusion of "Cysview" prior to the surgery and makes the CIS glow using the ultraviolet light. He actually gave my wife photos of the tumors while I was in recovery. You could see the patch clearly distinguishable. 

So yes, it seems that it might be hard to see CIS in some cases. I'm sure it depends on location, experience of the physician,  and lots of other variables.'
 
I looked at some of your former posts and didn't see a mention of BCG so not sure if you were treated with. In my case I had 24 total treatments and so far so good going on 5+ years. In fact I just went on a 1 year surveillance cysto (YAHOO!!) this last month.

Anyway - Good luck.

Peace and Love!!

08/16 Blood in Urine;09/16 CT Scan, RPG, Cysto;10/16 TURBT;12/08 BL TURBT;01/17 6X BCG;05/17 NED, 3X BCG, 9/17 NED, 3X BCG,1/18 NED, 3X BCG,7/18 NED, 3X BCG

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7 months 1 day ago #61329 by Alan
Replied by Alan on topic CIS after papillary tumor
If there is anything I have learned in life, it is "one day at a time" ( I know, easier said than done). Too many times tests and symptoms become something else than what we imagined and usually it is a nothing. JJ, ya just have to wait for pathology!

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.

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7 months 2 days ago #61324 by sara.anne
Replied by sara.anne on topic CIS after papillary tumor
 CIS appears like a rash on the surface of the bladder rather than as a discrete tumor.

A urologist cannot definitely identify cancer with cystoscopy.  Using a small camera, the urologist is able to actually look at the inside of the bladder. During cystoscopy the urologist sees areas of the bladder that may not look "normal."  These may or may not be malignant. 
In order to definitely diagnose the presence of cancer, samples need to be taken and sent to a pathologist who examines the cell structures microscopically.  This is what happens during a TURB.  While the urologist cannot make a definitive diagnosis during a cystoscopy, they have a lot of experience looking at the inside of the bladder!

Your urologist also sent samples of your urine to be examined for the presence of cancer cells that have been shed from the bladder lining  and none were found. Based on her experience and on the urine cytology your urologist seems pretty confident that what she sees is inflammation, and not bladder cancer.

BUT if you have concerns you should definitely discuss these with your urologist.

Sara Anne

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

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7 months 2 days ago #61323 by Jjbrown
Replied by Jjbrown on topic CIS after papillary tumor
Is it hard to see CIS on a cysto?

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7 months 2 days ago #61322 by sara.anne
Replied by sara.anne on topic CIS after papillary tumor
It is not uncommon to have some irritation in the bladder for no particular reason at all.    In fact, you can read my most recent experience
bladdercancersupport.org/forum/8-non-invasive-superficial-bladder-cancer-questions-and-comments.html
under "Non-Invasive."

I will admit that I was quite nervous, but it seems that it is all OK.  Your uro may want to keep a bit closer tabs on you for a while but she is probably correct that it is NOT something to worry about.

Sara Anne

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

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