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Urology (Expert Forum)
Re: bladder cancer
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Re: bladder cancer
by HFHS M.D.-MS, Jan 01, 1995 12:00AM
Posted By HFHS M.D.-MS on February 24, 1998 at 17:23:14:
In Reply to: bladder cancer posted by Judy on February 13, 1998 at 23:01:14:
Last week my husband underwent bladder surgery for removal of an apparent cyst. Following the surgery, the surgeon told me it was actually a tumor the size of a large plum but was all encapsulated and it showed no signs of malignancy and he felt he got it all and everything was fine. Today my husband went in for a checkup (I didn't go because I thought everything was ok). The doctor told him that the tumor was a "stage II" and that he would have to undergo a cysto procedure every 3 months to watch for reoccurence. He said if it had been a "stage1" then nothing would have been required and if it had been a "stage III" more aggresive (aggressive) treatment would be started immediately. Now my husband and I are both "in shock" and not sure where or what to do. Is it cancer or isn't it? What is a "stage II"? We have a 3 year old daughter and I am really upset but don't want to let my husband know how concerned I am. He does not read my e-mail so please respond honestly. Thank you.
Dear Judy
I am sorry you have received such anxiety provoking news. Of course, I do not have your husbands pathology report, but it sounds like he does indeed have cancer of the bladder. Urologist sometime use the term tumor and cancer interchangeably. In the US, we classify bladder cancer by the TNM system. The TNM system which stands for Tumor, Nodes and Metastasis. We are concerned with the Tumor part for now because your husband does not have evidence of spread of the tumor. The T part refers to the depth of invasion of the tumor into the layers of the bladder wall. The bladder is made of a lining called the urothelium, superficial muscle and deep muscle. The bladder is surrounded by fat. Ta is only in the urothelium. T 1 invades deeper just below the urothelium. T2 is when the tumor invades the superficial muscle layer ( inner half). T3a is when the tumor invades deep muscle or T3b the surrounding fat. T4 is when the surrounding organs are invaded.
We also talk about what Grade the tumor is. Grade 1 is more friendly behaving cancer and seldom invades deeply into the muscle. Grade two is mixed and has the machinery to invade and Grade three is often invasive into the deeper layers of the bladder.
It is important to talk to the Doctor with your husband and see just how serious or not so serious this diagnosis is. Based on the size of the tumor and the term stage 2 your husband may qualify /benefit from prophylactic chemotherapy that is temporarily instilled into the bladder by a catheter and then removed. There are several agents used with usually few side effects. Probably the best agent used is called BCG ( Bacillus Calmette Guerin) and comes from Tuberculous bacteria. It is placed in the bladder through a catheter tube in the urology clinic. This will be repeated each week for six weeks. It will increase the bodies immune system and cause the body to fight the lining tumor cells. It is best for superficial disease and not recommended for deeply invasive tumors. He will have some irratative urinary symptoms which usually get better after the treatments are discontinued. He can even undergo this treatment even if he has been exposed to Tb in the past. All instilled chemotherapy agents are thought to help decrease recurrence rate and prolong the interval to recurrence.
He will still have to undergo cystoscopies ( look inside the bladder with a lighted telescope) every three months and if no recurrences are seen, then he can decrease this to every six months after one year. Urine samples for cytology (looking for shedded tumor cells) will also be used to help detect a recurrence. If he does have a recurrence then the tumor will have to be removed like the first one.
It is good that your Doctor reported he thinks he got it all but bladder tumors are thought to be a multi-focal disease, and the entire urothelium is at risk of developing a tumor in the future. Also smoking is a risk factor smoking and is known to increase the risk of bladder cancer by six fold.
Prognosis for superficial disease is 85 - 90 % 5 year survival and a 10% chance of progression overall. Muscle invasion treated by removing the bladder surgically ranges from 55 to 60% 5 year survival. Distant disease has an even worse prognosis.
Hope this has helped give you some info and questions for your doctor. You are always welcome to a second opinion at Henry Ford Hospital. 1-800-653-6568 will get you an appointment.
Good Luck.
Now for the necessary disclaimer.-
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS M.D.- MS
*Keyword: Bladder cancer
In Reply to: bladder cancer posted by Judy on February 13, 1998 at 23:01:14:
Last week my husband underwent bladder surgery for removal of an apparent cyst. Following the surgery, the surgeon told me it was actually a tumor the size of a large plum but was all encapsulated and it showed no signs of malignancy and he felt he got it all and everything was fine. Today my husband went in for a checkup (I didn't go because I thought everything was ok). The doctor told him that the tumor was a "stage II" and that he would have to undergo a cysto procedure every 3 months to watch for reoccurence. He said if it had been a "stage1" then nothing would have been required and if it had been a "stage III" more aggresive (aggressive) treatment would be started immediately. Now my husband and I are both "in shock" and not sure where or what to do. Is it cancer or isn't it? What is a "stage II"? We have a 3 year old daughter and I am really upset but don't want to let my husband know how concerned I am. He does not read my e-mail so please respond honestly. Thank you.
Dear Judy
I am sorry you have received such anxiety provoking news. Of course, I do not have your husbands pathology report, but it sounds like he does indeed have cancer of the bladder. Urologist sometime use the term tumor and cancer interchangeably. In the US, we classify bladder cancer by the TNM system. The TNM system which stands for Tumor, Nodes and Metastasis. We are concerned with the Tumor part for now because your husband does not have evidence of spread of the tumor. The T part refers to the depth of invasion of the tumor into the layers of the bladder wall. The bladder is made of a lining called the urothelium, superficial muscle and deep muscle. The bladder is surrounded by fat. Ta is only in the urothelium. T 1 invades deeper just below the urothelium. T2 is when the tumor invades the superficial muscle layer ( inner half). T3a is when the tumor invades deep muscle or T3b the surrounding fat. T4 is when the surrounding organs are invaded.
We also talk about what Grade the tumor is. Grade 1 is more friendly behaving cancer and seldom invades deeply into the muscle. Grade two is mixed and has the machinery to invade and Grade three is often invasive into the deeper layers of the bladder.
It is important to talk to the Doctor with your husband and see just how serious or not so serious this diagnosis is. Based on the size of the tumor and the term stage 2 your husband may qualify /benefit from prophylactic chemotherapy that is temporarily instilled into the bladder by a catheter and then removed. There are several agents used with usually few side effects. Probably the best agent used is called BCG ( Bacillus Calmette Guerin) and comes from Tuberculous bacteria. It is placed in the bladder through a catheter tube in the urology clinic. This will be repeated each week for six weeks. It will increase the bodies immune system and cause the body to fight the lining tumor cells. It is best for superficial disease and not recommended for deeply invasive tumors. He will have some irratative urinary symptoms which usually get better after the treatments are discontinued. He can even undergo this treatment even if he has been exposed to Tb in the past. All instilled chemotherapy agents are thought to help decrease recurrence rate and prolong the interval to recurrence.
He will still have to undergo cystoscopies ( look inside the bladder with a lighted telescope) every three months and if no recurrences are seen, then he can decrease this to every six months after one year. Urine samples for cytology (looking for shedded tumor cells) will also be used to help detect a recurrence. If he does have a recurrence then the tumor will have to be removed like the first one.
It is good that your Doctor reported he thinks he got it all but bladder tumors are thought to be a multi-focal disease, and the entire urothelium is at risk of developing a tumor in the future. Also smoking is a risk factor smoking and is known to increase the risk of bladder cancer by six fold.
Prognosis for superficial disease is 85 - 90 % 5 year survival and a 10% chance of progression overall. Muscle invasion treated by removing the bladder surgically ranges from 55 to 60% 5 year survival. Distant disease has an even worse prognosis.
Hope this has helped give you some info and questions for your doctor. You are always welcome to a second opinion at Henry Ford Hospital. 1-800-653-6568 will get you an appointment.
Good Luck.
Now for the necessary disclaimer.-
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS M.D.- MS
*Keyword: Bladder cancer
