Bladder Cancer Diagnosis and Treatment Questions

[aggiedent]

My mom was diagnosed with Bladder Carcinoma this week. 81 y.o. in generally good health. Had pain urinating a year ago. Diagnosed as an infection and treated with antibiotics successfully. About 2-3 months ago started feeling tired but no weight loss. About a month ago started bleeding in urine, no pain, and passing stones.

Urologist requested a CT scan and x-ray. He said they showed stones (one or two big ones) and nothing else. Gave her 2 weeks to try and pass them. No luck. Scheduled surgery. Upon opening bladder discovered a large tumor. Biopsied and removed stoned. Carcinoma. Histology showed that this sample had not penetrated muscle. Wants to run a few tests including a full body scan. Says he will "scrape" out the tumor and place chemotheraputic agents in the bladder, unless it has penetrated the muscle layer, in which case he will remove the bladder. In the mean time my mom does not feel well and is fairly tired. My mom is normally a very energetic 81.

Questions:
1. Is it really possible to have a large tumor and not see it on a CT scan or X-ray?
2. At her age, with bleeding and fatigue, should this have sent up alarm bells and been acted upon more urgently?
3. We live in the suburbs of Houston and she is seeing a suburban urologist. Would she be better in a cancer center like MD Anderson Cancer Center?
4. Any tips (besides asking a lot of questions after doing internet research) on what to do?

I'm a DDS myself and I don't ask questions 1 & 2 thinking of legal repercussions, but I'm just not getting a good feeling about the way things are going. Call it intuition if you will.

Thank You

[keyzersoce]

I am not a doctor and can only speak from personal experience. When blood appeared in my urine, a CT scan was ordered to check for possible causes, i.e., stones. Scan was clear but showed a mass inside the bladder. Urologist said a CT scan could not clearly show what the mass was and he needed a to look inside with a cystosocope, When he did, he discovered the tumor.

After removal and pathology tests, it was determined to be a surface tumor. Standard treatment is installation of BCG into bladder once a week for six weeks; sometimes they add other agents, such as mytomycin. If the tumor has penetrated the muscle wall, then partial or complete bladder removal is done.

I am inferring from your post the urologist just assumed stones were responsible for the bleeding and did not investigate further. However, as in my case, the scan should have revealed some mass in the bladder, unless the scan wasn't of the pelvic area(just abdominal) or the radiologist misread the results. I thought it was standard to do a cysto  before any procedure so you might ask him why he did not.

Although I am 2,000 miles away, I can tell you the Anderson Cancer Center has as distinguished a reputation as Johns Hopkins or the Mayo Clinic.  However, you have to talk this over with the patient(your mother). She may be comfortable with her current doctor or not willing to go through the hassle of travelling into the city all the time. At the least, I think it would be worth consulting one of their urologists with her records simply for a second opinion.

As a DDS, you know this is a tough call overall. I'm sure people often ask you about dental problems you should have foreseen or that occurred despite your efforts to stop them.

Best wishes to you and your family.