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Another quick question re my father

1 year 8 months ago #57401 by RJake1
This is very similar to my own recent diagnosis. Your radiologist found it to be HG non-invasive. I would expect BCG to be next course of treatment.
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1 year 8 months ago #57387 by Alan
Just seconding Sara Anne's response. Just clarify what the doctor is saying and it appears he is saying it is non invasive. The doc's comments actually seem to me is "barking up the right tree" and BCG probably is the answer. I am not an insurance expert but, I'd be very surprised if Stanford doesn't take Medicare. The problem sometimes arise with the supplement. Usually the institutions insurance department can cover this one quickly. I had the same situation with MD Anderson in Houston which I have as a backup and thankfully I didn't have to go plus they took most supplements including mine. Their problem came up with Medicare Advantage supplements just for reference. The option if it is Medicare and not the supplement, would they take the 20% difference that a supplement normally covers to keep the cost down?

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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1 year 8 months ago #57385 by sara.anne
I don’t think you should make any decision until you speak with the doctor on Monday. You should ask him about his certainty about the diagnosis and his plans going forward. I wouldn’t say that he is necessarily being nonchalant.

Usually if there is any uncertainty a second TURB is done but since this involves general anesthesia you would want to be sure that it is necessary. This would be the reason to discuss with the doctor the meaning of the path report. The path report states multiple times that there is no evidence of invasion so you should ask for an interpretation of this statement.

The usual treatment for this diagnosis would be BGG

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
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1 year 8 months ago #57384 by Neelloo2626
Hi All-

I posted earlier about my dad but now I am thinking we need to change my dad's doctor!

His pathology states the following:

Microscopic Description: Specimen A: Sections from the bladder right lateral wall show a high grade papillary urothelial carcinoma. Although some of the fragments appear severely distorted by cautery artifact. An area of cystitis glandularis is noted. I have not identified evidence of invasive carcinoma.

Specimen 8: The biopsy of the base of bladder tumor shows additional fragments of high grade papillary urothelial carcinoma. No evidence of invasive carcinoma is identified_ I have not identified muscularis propria despite multiple levels.

Synoptic Comment:
Procedure: TUR BT
Tumor Site: Right lateral wall
Histologic Type: Papillary urothelial carcinoma
Histologic Grade (non-squamous): High grade
Muscularis Propria Presence: Muscularis propria (detrusor muscle) not identified
Tumor Extension; No evidence of invasion Lymphovascular Invasion: Negative Pathologic Staging

Does the Muscularis Propria not present despite multiple layers mean the doctor did not obtain enough tissue sample to tell us if it went into the muscle wall?

Then how can he diagnose non-invasive if they have not obtained enough tissue?

Please help! Doctor sent an email to my dad indicating that the cancer is non-invasive and no further surgery was necessary but would discuss with "management" with my dad on Monday.

I dont think my dad's insurance covers Stanford so I am not sure what to do- he has Medicare but also as a supplement but it is not an NCI.

Any insight into this would be MUCH appreciated. I know the opinions on here are of survivors but I am thinking this doctor is taking a very non-chalant approach to my dad's care.

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