Carcinoma In Situ diagnosis

Update: Last week I had a Cystoscopy and cytology test. Thank God they were both negative. Now I start the BCG maintenance program. 

Hy Clyde,

I think it's standard procedure for them to do a follow-up turbt afterward. With this turbt, they typically look really closely at the area and sample anything remaining that looks suspicious. They also clean up the margins of the previous surgery. For me, there was a 6 week period between the 2 turbts - This gives it time to heal a bit, and for the swelling to decrease. It also allows some time for pathology of the biopsies.

The last time I had a cystoscopy (less than 2 weeks ago), my urologist took a couple biopsies. The sampling equipment looks like small alligator jaws, and I was able to watch on the monitor while the biopsies were taken. Subsequently, the areas were cauterized to prevent further bleeding. The whole thing was relatively painless, and I recommend it (as opposed to the complications of a turbt). Maybe they could do this for you, since there's not really been a formal diagnosis of CIS.

Mike

Hi Mike,

The cystoscopy was done in the office and he did not do any biopsies. He didn't think the subtle red area was a concern at the time but now with the suspicious cytology results he wants to go back in and take a more thorough look and scrape out and biopsy any area that doesn't look normal. He didn't see any lesions. The only concern is CIS, He didn't say anything about a second turbt. I know when I was originally diagnosed that URO-oncologist didn't suggest a second turbt. He wanted me to just start BCG. I was feeling pretty good about my bladder after the cystoscopy, I seen the bladder and I didn't see any red at all. The last time I had a cystoscopy I had allot of red which he thought was inflammation.

Hi Clyde,
When they did the cystoscopy, did they perform a biopsy, and if so, did they send biopsy(s) to a pathology lab for analysis? It seems they could sample this area without doing a turbt.

Correct me if I'm wrong, but if they do a turbt, won't they have to another follow-up turbt after the biopsies are analyzed? -I believe it's standard procedure to have a "clean-up" turbt following the first turbt.

Mike

Update: After completing my initial 6 weeks of BCG in the beginning of December I had a cystoscopy in the first week of February, Overall the Dr said the bladder looked good but there was one small area of "subtle" redness that we need to keep an eye on. At that time he didn't think it was anything to be concerned about. I had a cytology test done on the same day. The Cytology test came back as " suspicious". This caused us to rethink our strategy. So our options were to go ahead and do the 3 maintenance BCG and recheck in 3 months. But if the subtle red spot was there then we would do a turbt to biopsy. If it was CIS then I would be done with BCG and we would move on to chemo. The second option was to go ahead and do the turbt now to get a biopsy and thoroughly check the bladder. If he finds any CIS then he can scrape it out and do another round of 6 BCG treatments. As a side note this uro never did a turbt on me. I switched to a Uro from an NEC institution after my initial DX. We decided to go with the 2nd option since it's more thorough and if anything is found I would be able to get 6 BCG treatments. He will also do some xrays of the kidneys while I'm in the OR. If nothing is found then I can probably just go into maintenance. I'm not sure how accurate these cytology tests are but it is my understanding they are pretty good with CIS. Even though they didn't say I had malignant cells we felt suspicious was too close for comfort. Has anyone else ever had a "Suspicious" cytology test?

Thanks Swarmy, That is good advice to drink allot of water everyday. It keeps flushing the bladder and I believe it can reduce your acidity in your urine. From what I read the "bad' cells like acidity. I'm sure it's good for the kidneys as well.