It also discusses the usefulness of substaging T1 tumors into T1a,b or c.
Most important is that the pathology specimen contained muscle tissue. As stated in "Review Pathology: why it is critical", "T1 tumors are downstaged to Ta between 35-53% of cases, while between 3 and 10% of them a T2 or higher is considered."
There can be discrepency between pathologists because it's a subjective field, that's why experience really counts.
Sometimes one tumor can have high grade components, or there may be aggressive cellular changes in the bladder lining but no tumor that can be seen (CIS).
The above link is a review of a presentation that discusses the limitations of pathology and how best to get an accurate diagnosis, "Papillary tumors may show heterogeneity (dissimilarites) of grade. It remains to be defined what percentage (if any) is minimally needed to place tumors in a higher category when the highest grade is focal."
It's pretty common for those with T1 tumors to be given a follow up TUR a few weeks after the first, but not as common if it is low grade. As far as whether treatment is needed, it depends on where you go and who you talk to, as well as patient preference. Some doctors complain that they are forced to overtreat people who had low grade tumors removed because of patient anxiety and the desire to feel they are actively doing something to fight the cancer recurring, as opposed to watching and waiting. Over-treating is just as big an issue as under-treating.
BCG is very effective at reducing recurrence in high grade tumors, but less effective in low grade tumors. Intravesical chemo has been shown to delay recurrence, but the benefit wears off in two years. Both treatments have side effects and risks, long and short term.
The best case scenario for you would be that you have no residual tumor at the follow up, it's been shown that most recurs come in the first year. Sometimes bladder tumors just stop coming, it really happens. I hope you're one of those!
<In this context I wonder if perhaps the pathologist who graded your tumor as II really means I, or is it leaning more towards the III end?>
Summary stated low grade then in the detail portion of the report called it grade II - which confused me a bit when I got home and read it. Doctor refered to it as low grade. Should one consider speaking with the pathologist to clarify?
>BTW...who was the sadistic individual that came up with the penis clamp? <
Uhm, that would be the same guy who invented the mammogram.
I read your story. It's true that a T1 dx would normally call for treatments or a second check, unless it's low grade. These days uros are trying to get in line with each other, make staging more clear. It used to be they graded from I-IV, then it went to only grade III being the worst or highest, now they are talking about calling tumors either low or high grade. No more grade II!
In this context I wonder if perhaps the pathologist who graded your tumor as II really means I, or is it leaning more towards the III end? If so, seek treatment. If not, waiting and watching just might be fine.
Many folks get second opinions on their pathology reports as well as their uros. If your path was done at a reputable lab, cancer center or university hospital,, great. If it was done in a small local clinic, then, hmmm.
It's a rocky, confusing road you've just set out upon, but when the diagnosis is cancer one can never be too careful or too knowledgable. Also, a uro-oncologist, someone who specializes in bladder cancer and knows the complicated ropes would be a good thing to have.
Im in UK so can't really say where id go. I'm under the care of a uro oncologist and I think that's good advice you got. I also found this flowchart from MD Anderson Cancer Centre which makes it pretty clear that they'd be doing just as Rosemary suggests and rechecking for residual tumour, further invasion and starting a 6 week induction of BCG as well as "considering" an early cystectomy. It's quite an interesting chart. The early cystectomy I'm not sure about as there are people who have a complete response to BCG with T1 disease and I'd probably want to give that a go as many people do. I had a cystectomy but I'd had recurrent multifocal disease for 14 years with BCG resistant G3 tumour and CIS so my case is different to yours. But Rosemary's advice makes very good sense. Maybe it's something to print off and show your doc by way of introducing the subject. Page 2 is the bit that should interest you.
I think your doctors is not aggressive enough. Get a second opinion! I suggest seeing a urologist oncologist. Take all your films and pathology with you. How old are you and where are you located? I had only cysto surveilance but I had a ta grade 2. If your tumor was in the lamina are they sure it was not also in the muscle? The path report should say if there was muscle in the slide. Be careful and good luck.
I have to agree with both Rosemary here first you do want to know if your Dr got all the tumor and also Tims comments. I don't quite understand this treatment thing as a wait and see. If this was me I would be asking Doc about starting treatments. I have a G3 stageT2 which is muscle invassive and you can read my treatment post under Invasive Bladder Cancer in forum. Also is this the first urologist you saw cause you can always get a second opinion ( Why wait 3 months it's your life) not that is going to change the stage but you may find another urologist will not say to you wait and see. To me with this disease at any stage I am not going to play any wait and see. Tim is a %100 correct about this board it is the best on the net and there is alot of suppport and some valuable info I am so glad I found this place. Think positive "going" and if I were you I would be pounding my Dr with questions don't be afraid to fire them at him. If you are not satisfied as with me I went and got that 2nd opinion the best decision of my life. To give you an idea about this board I am being treated at the Univ of Penna in Philadelphia an excellent hospital and this forum is well known up there that says a mouthful right there being known by some top notch Dr's in this field. Wishing You The Best, Joe