In an effort to convey my situation to all of you in one swoop, I thought I would post some information.
I had a routine urinalysis in April 2008 at the Veteran's Administration during an annual physical. That test came back atypical and my primary doctor ordered a FISH test; a test that detects cancerous cells in the urine. The results of that test were positive for bladder cancer so I was referred to a Urologist within the VA system. The Urologist performed a cystoscopy which visually confirmed the test results. On June 10, 2008 I had a procedure called a TURBT which was performed in an out-patient setting under general anesthesia. The TURBT allowed the doctor to view and remove biopsies from inside the bladder.
The results of the biopsies indicated the following:
"High grade urothelial dysplasia, non invasive and high grade urothelial carcinoma with lamina propria invasion, no muscularis propria invasion identified".
The Stage and Grade of the cancer are important factors contributing to the prognosis. The stage refers to how far a cancer has progressed and the grade refers to the aggressiveness of the cancer. My cancer is high grade (G3) and the stage is non-invasive (T1). This means the cancer is very aggressive and has not yet penetrated the muscle. Once the cancer invades the muscle the prognosis worsens and can more easily metastasize, which would change the whole situation; from prognosis to treatment. The one other factor is the dysplasia or Carcinoma in Situ (CIS). This cancer is very aggressive and unpredictable. Unfortunately pathology reports are subjective and limited to the actual biopsy slice being evaluated. Path reports of this type are also many times (40%) understated.
I have had consults with 3 surgeons; one in San Diego at the VA hospital, one at UCLA and one at USC.
My options are to either have BCG treatments or a radical cystectomy. (Those of you who know my philosophy on many 'problems' is to ignore said problem; that won't work with this one).
I have decided to have the radical cystectomy at USC. The surgery is expected to take 8 hours. It is an open abdominal surgery in which the bladder, prostate (nerve-sparring) and 50 or so lymph nodes will be removed. A neo-bladder will be constructed using some of my small intestine and the neo-bladder will be connected to my urethra. This is all pending the observations made by the surgical team during the surgery at which time they can get a better idea of the extent of the cancer. I will be in the ICU for 1 or 2 days following the surgery and I am expected to be in the hospital for 10 days. Upon discharge from the hospital, I will have at least 2 tubes exiting my body; a drain and a catheter. These are scheduled to be removed 3 weeks after surgery.
This should get everyone 'up to speed'.
I am including some links if you want further detailed information.
The American Bladder Cancer Society
Bladder Cancer Web Cafe
American Cancer Society
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3 comments:
Hi Steve,
My father needs the surgery and has been refered to Kinner at USC or Smith at UCLA which doc would you recommend?
Thank you
Tina from Santa Barbara
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