My father (78) was recently diagnosed with bladder cancer. The tumor was large (5 cm), mixed papillary-solid and located on the left posterior-lateral bladder wall, but they couldn’t remove everything during the first TURBT because he had severe macrohematuria with blood clots.
The pathology report (just one page) says:
"Multiple fragments of high-grade urothelial carcinoma (ISUP-WHO, 2004) G3 (WHO, 1973), diffusely infiltrating the subepithelial connective tissue and the muscularis propria fragments present in the sample. (pT2)"
The report doesn’t mention any immunohistochemistry, so I assume it wasn’t performed. I don’t know if this is standard practice, but how can they be so precise with the diagnosis based only on tissue fragments and without immunohistochemistry?
Anyway, these fragments were analyzed by a relatively young pathologist, who from what I found online seems to be a resident doctor or a specialty trainee in the final year or recently finished. Because of this, and the fact that no immunohistochemistry was done, we are considering seeking a complete TURBT and a second opinion elsewhere. Did any of you have your pathology report changed after a second opinion?
We talked to our oncologist and he only offered chemo plus radical cystectomy, but only after doing another chest CT scan to double-check for lymph node metastases. He didn’t explain why RC is the only option, nor did he discuss prognosis or surgery risks and side effects. When I asked about bladder preservation with turbt, chemo and radiation (trimodality therapy), he said the tumor was too big (it was 5 cm before TURBT, no idea about the size now) and that radiation would be ineffective. Recently I learned about a promising and less invasive therapy for bladder cancer called photodynamic therapy (PDT), but I can’t find much information online, probably because it’s not widely offered to most patients.
I’ve read that RC is only about 50% effective and that, in some cases, it might even contribute to spreading cancer cells or cause sepsis, which really scares me. My dad has told me he doesn’t want his bladder removed because he doesn’t want to spend his remaining time with a stoma bag or in worse physical condition. He would also likely refuse chemo and radiation, because 13 years ago he was wrongly diagnosed with Non-Hodgkin B-cell lymphoma (Grade 3, Stage 2A). He refused chemotherapy back then and lived without any issues for all these years, although his left kidney was permanently damaged. Now, coincidentally, it’s G3 T2 again, but this time in the bladder.
Did anyone here refuse treatment for G3 MIBC? What was your experience?
Hello Jayk and welcome to the group although sorry to hear about your father. In most cases there will be a follow up TURBT to clear up any residue and give a more accurate diagnosis. If you mean your father did not have a mitomycin chemo wash after the TURBT, this is not unusual. If the cut is deep, they cannot use chemo in case it seeps through the wall and in to the bloodstream. Many here have had successful bladder removal and should be along to offer their experience. I was T3/G3 and went the chemoradiation route. Has your father been allocated a CNS (Cancer/clinical nurse specialist? If so. these are the best people to get information. I hope all goes well. Best wishes.
