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3 years 9 months ago #51240 by jfmmeyer
Ok more questions, sorry just a "ball of nerves." I've suffered for years with anxiety. And never had surgery, only tubes put in my years when I was little. I remember they put me to sleep still remember being dizzy and a loss of control. But people who know me would never know I suffer from anxiety's. So even though I've read that you can get a spinal, most do a TURBT via general anesthesia? FUrthermore, I'm still confused isn't the biopsy a good indicator of what is the tumor even though they didn't take out the tumor(see my earlier post). Sorry for babbling on.... I'm just thankful and grateful for support.... Though my wife is worried I'm writing this... Thanks again, Jim

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3 years 9 months ago - 3 years 9 months ago #51239 by Alan
To add to the discussion. Sara Anne has done an admirable job summarizing. A real talent. I just want to add I was in your shoes 8 years ago and stronger and better person for it. You are on the way to answers and beating this. I am adding comments to one of your concerns of anesthesia. I too had concern because of some family history but, after 5 surgeries (2 hernias, 2 TURBs, 1 ligament tear in my wrist all about 1 hour) the guys doing it have been real pros. Mayo will be on top of it!

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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3 years 9 months ago #51238 by sara.anne
I love questions with easy answers! The answer is: It all depends!

Seriously, is does depend on how much time the uro needs to remove as much of the tumor as possible and get really good samples to send to the pathologist, and that does depend on whatever he encounters when he actually gets inside the bladder.

In my case (I have had two TURBS) I went into the hospital outpatient surgery unit about 8 a.m. and was able to have a (groggy) lunch on the way home. I did not have a catheter. Occasionally I have known of people who did stay one night in the hospital.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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3 years 9 months ago #51237 by jfmmeyer
Hello Sarah Anne,

How long does a typical TUR take?

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3 years 9 months ago #51236 by sara.anne
LOTS of questions!! First, do I understand correctly that you had a biopsy without anesthesia? The uro just took a sample during a cystoscopy? (OUCH) That is NOT the usual procedure, and if that is what was done, it is no surprise that there is still a mass there. In addition, since there was no muscle or submucosa present, they had no idea whether the cancer was completely localized or not. Usually the uro sees evidence of a problem while looking during cystoscopy, and schedules you for a TURB. During the TURB (yes, under general anesthesia) the entire mass or as much as possible is removed and that is sent to the pathologist. Trying to remove a mass of any size whatsoever and getting the entire thing without anesthesia would be impossible. And often a second TURB is scheduled a month or so later if there is any question at all about the initial diagnosis.

The TURB is not a long procedure, and you will not be under very long at all. It would be very unusual and probably not considered good medical practice to give a spinal for such a relatively minor procedure, but you can ask your doc about this. There are just too many possibilities for some really unpleasant side effects with a spinal!

You may, or may not, have a catheter after the TURB for a day or so. It is more common with males, and depends on how much "damage" the uro does in removing the samples, and where they are located.

You did absolutely the correct thing in seeking a second opinion/consult at Mayo. If you hadn't, you would still be walking around with a cancerous growth in your bladder!!

I guess, to summarize the answers to your questions,
1. No,the way your "biopsy" was done the first time is NOT typical
(and as you can see, not very effective.)
2. The original path report is probably completely accurate CONSIDERING THAT THE SAMPLES SENT TO THE PATH LAB WERE INCOMPLETE. The tiny pieces were analyzed OK, but there was not enough tissue, none of the muscle or lower layers were included so no one knows if the tumor invaded them or not.
3 & 4 ...think I already answered
5. The biopsy was very incomplete. All the report told you was that there was low grade cancer in those pieces. In addition, he left most of the tumor there instead of removing it. In my case, my first TURB showed low grade papillary tumors, and some areas of "irritation" but the pathologist was unsure what it was. Back for a second TURB and the "irritation" turned out to be high grade CIS! Without the second look, I would have been in big trouble! The TURB you are going to have should give you a more complete diagnosis.
6. It isn't the size so much as the grade and extent that it may or may not have gone into the muscle and other layers of the bladder. That is why you need the TURB. You and the new urologist will then be in a much better place to discuss treatment.

With a little luck the path report will still be low grade, non-invasive. And you will be confident of the diagnosis.

Will keep my fingers crossed for you

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
The following user(s) said Thank You: jfmmeyer

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3 years 9 months ago #51235 by jfmmeyer
Hello again, well I have an update. In 5/17/2016 I went in to a local urologist who did a cystoscopy and did a biopsy. The biopsy report came back "Papillary urothelial carinoma, low grade. No underlying submucosal or muscular wall tissue presented." It said on the report it consisted of "four pieces measuring an aggregate of 0.3 X 0.2 x 01 cm. I went to my primary to discuss and my wife and I went to Mayo Clinic to see a Dr. Boorjrian. We met yeterday, I was thinking it was going to be another cystoscope. But he didnt, and that based on what they saw on the CT w/o contrast they said that it should come back in three months; however since the other urologist didnt do the CT with contrast they ordered one for me to do today. Well I did performed the CT w/ contrast and my wife and I came home . I received a call from the drs. PA who said that they still saw the mass in my bladder which the radiologist though is was around 3cm and to have me come back to do the TURB. So with that being said and now confused I have some questions:
1. Is this the typical way to do this biopsy first then TURB if needed?
2. Does this mean the original pathology report is wrong?
3. During the TURB can you do a spinal( still be awake) instead of anethesia? I'm so afraid of being put to sleep?
4. They said once the TURB is done that I will probably have a catheter? Is this standard?
5. Since they already did the biopsy what will the TURB tell me?
6. 3cm sounds big?

Please help so so confused and scared. Thanks again for your support and honesty.

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