I am s/p RLL lobectomy for Stage 1 Adenocarcinoma (BAC) and s/p hysterectomy and vaginal radiation for stage 2 endometrial CA. On my 2 yr. follow-up CT, a small enhancing nodule anterior bladder wall suspicious for transitional cell cancer was found. I am trying to educate myself before I see the urologist and I have been reading the NCCN guidelines. I am uncertain about one point that I hope someone can help me with this.
When there is a suspicious bladder lesion a cystoscopy with biopsy is performed for staging. If there is non-invasive disease, a TURBT is done. If the tumor is cTa low grade, then consideration is given for a single dose of intravesical immunotherapy/chemotherapy. My understanding is that this single dose is given out of concern for seeding of cancer cells from the tumor excision. My question concerns the seeding concept. Why isn’t there concern about seeding when the bladder biopsy is done?
I have one other question. I live on the east coast close to Baltimore. I plan on seeing someone at Johns Hopkins but the head of the JH bladder clinic is leaving and the other bladder specialist is not doing bladder biopsies. I will be consulting with an urologist (my gyn-onc surgeon’s recommendation) at JH whose specialty is prostate cancer (he does do bladder biopsies). I anticipate wanting to get a get second opinion if the pathology is positive for cancer.
Any recommendations for urologists who has a specialty in bladder cancer either at the Cleveland Clinic or some other major medical center on the east coast?
Fri, 02/28/2014 - 16:27
Hi ds, Welcome to Grace. I will ask one of our oncologist to comment on your questions and hope you find yourself well with no additional need of cancer treatment, seems you've already had your share.
Sun, 03/02/2014 - 07:20
ds, so sorry I didn't get back to you sooner. I'll try another route. You'll hear back today.
Sun, 03/02/2014 - 10:23
I don't know if Dr. Pal, a medical oncologist specializing in kidney and bladder cancer, will be able to offer a thorough answer. Perhaps, but I think your questions are really in the realm of a urologist's purview (the surgeon who diagnoses bladder cancer by doing these biopsies). I suspect that there is exceptionally little, if any, actual evidence to speak to the incidence of seeding from a biopsy, and that the practices related to it are largely based on judgment (or "voodoo", if you want to look at it that way). I doubt there has ever been a study to show that giving intravesical therapy improves outcomes in any way. The guidelines are written replete with lots of things to consider, usually implying "we really have no idea if this is helpful, but who knows?". I wouldn't want you to infer that there's actual evidence to support these general musings, unless Dr. Pal knows something to speak to this, or a urologist you speak to has some significant insight to add.
Also, I'm afraid I'm too far from that part of the country to make a recommendation for a urologist, but frankly I would be stunned beyond words if Johns Hopkins truly doesn't have a urologist up to the task -- it's an extremely strong program.
Sun, 03/02/2014 - 21:40
I agree with Dr. West's suggestions here. I am not aware of a substantial risk of seeding from a biopsy, but would concur that the best individual to address this is a urologist (I'm a medical oncologist, focused on more advanced stages of the disease). I agree that Johns Hopkins has an outstanding urology program. Although I can't single out one particular urologist you should see there, I think that they will be well equipped to handle your situation.
Please note that this information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.
Mon, 03/03/2014 - 07:34
Thank you Dr. West and Dr. Pal. I appreciate your taking time out of your busy schedules to respond to my questions.