It's helpful to read your history all in a row like this, although it's not exactly light reading! That's the trouble with bladder cancer, it sometimes shows up with different types of tumors found together. I've often heard of low and high grade, or papillary (usually low grade) showing up with CIS-always high grade. It does make treatments tricky in the face of your unusually bad side effects.
Dr. Lamm's answers were great. Of course the point is, there is no "one" answer, that's the nature of cancer treatment.
MCC is Urocidin, there's a page about it on webcafe, also on KLH, which is an immotherapy that for some strange reason never took off although it seemed to hold much promise.
I'm glad you are clear right now. Thanks for your post.
This is the reply from Dr. Lamm re: the interuption of my BCG treatments because of reactive psoriatic arthritis.
Alternatives to BCG Treatment
Thank you for your work on Web cafe and the help you provide bladder
cancer patients. Yes, Dr. Patrick Walsh was a urology resident when I was
a student at UCLA, and later was on staff at the Naval Medical Center in
San Diego when I was a resident.
It is hard to say if you should receive your next course of BCG or not.
It is a risk/benefit question, and both are fairly high. If you do decide
to proceed with BCG, which would be a reasonable decision, I would suggest
that the dose be very signigicantly reduced, say to 1/10th. An
alternative would be to add interferon to increase the local response
(with lower BCG) without increasing systemic side effects. If the tumor
should return you could be a candidate for MCC (see the Bioniche website
for sites). You might also benefit from KLH. Check the website for more
information on KLH that should be posted shortly.
Don Lamm, MD
> Below is the result of your feedback form. It was submitted by
> question: Dr. Lamm,
> Hi. My name is Rosemary Osterhus and I live in New Bern, North Carolina.
> I work with Wendy Sheridan as a moderator at the Bladder Cancer Web Cafe.
> You previously answered a couple of questions for me about a reactive
> arthrits in connection with BCG treatments. You gave your opinion that
> the arthritis and BCG's were connected. I took your E Mails to my
> Urologist , Dr. Patrick Walsh (he told me that he has worked with you
> When it was finally determined that the arthritis was Psoriatic Arthrits,
> Dr. Walsh determined not to continue with BCG's. For the record, the
> arthritis is better, but in no way gone. I was pretty crippled after BCG
> #9 which was in October of 2006. . The arthritis came on like gangnusters
> in November.
> My question is this...do you agree that I should not proceed with BCG
> #10?. I am due for 3 more as of this date.
> There has been no recurrance of BC since March of 2006. By all accounts,
> my bladder looks "great".
> I am most appreciative of your replies.
> The following are notes from Dr. Raj Pruthi at UNC Chapel Hill where I was
> referred last May, when my superficial BC was upgraded to T1 G3. Dr.
> Pruthi subsequently did a biopsy obtaining muscle tissue which was totally
> clean. These notes are from May 2006.
> Thanks very much, once again.
> (Also, the CT scan Dr. Pruthi required showed no abnormalities).
> 'With sincere respect, ,Rosemary
> "The patient is a 53-year old female with a history of hematuria and urine
> cytologies, which are negative, who recently underwent evaluation in
> January of this year and was noted to have a bladder tumor for which she
> underwent transurethral resection of the bladder revealing a papillary
> low-grade tumor .
> She underwent repeat transurethral resection. Of note, this was all Ta
> grade 1 disease. She received postoperative mitomycin therapy, underwent
> repeat transurethral resection in 3/2006. With small amount of residual
> tumor, underwent transurethral resection of this area. No muscle was in
> the specimen. This was predominantly a low-grade tumor with a focal area
> of high-grade disease. This was adjacent to the right ureteral orifice.
> She underwent a ureteroscopy also, which was negative. She now presents
> for evaluation of her T1 focally high-grade urothelial carcinoma. Feeling
> well. No dysuria, no bony pain, weight loss or other somatic complaints.
> agree: yes
> Submit: Submit Question
Age - 55
T1 G3 - Tumor free 2 yrs 3 months
Dx January 2006