Questions from a BC beginner.....

Thanks, you are awesome... I am not sure what "overstaged" means. I read the article, and it seems to me that their conclusion is that there are/were many false positives for lymphovascular invasion, and that they used a different type of dye, or method of dying (sp?) Is this your take from this article?

I am inclined to let Dr. Huang do the 3rd TURB..... He said that after a few hours of scraping, the bladder was so irritated and swollen that they couldn't be sure to have gotten every last bit of the cancer.

I plan to contact the Cleveland Clinic for a second opinion, let them look at the reports and slides, and see if they need to take a look.

Thanks again for the research.

Thank you Pat, Jack, and Mike.

Yes, the 2nd report is from UPMC

I believe that my first TURB was just to collect samples, as my first Dr. felt that the bladder was not salvageable, and most of the tumors were still present at the 2nd TURB.

I am scheduled for a 3rd TURB on April 20 at UPMC

I see that some things are in the report are definite, and confirmed by a 2nd Dr., and some are suspicious. Is this normal in these reports?

Thanks for helping with my education, I am starting to understand some of this, but I find much of this a bit depressing. Head in the sand feels better, but I am guessing that educated choices will get a better result.

John

hmmmm...suspicious for............" When ambiguous terminology is used, p. 20 of the CS manual indicates that "suspicious for" should be handled as involvement of the stated organ or structure" read that from a pathologists handbook. Thats about as ambiguous as you can get huh? Also found an article from Johns Hopkins which says that "suspicious for lymphovascular invasion" may be overstaged.

www.ncbi.nlm.nih.gov/pubmed/2408038?dopt=Abstract
Anyway what i think all of this means is that it is of the utmost importance that you have a top notch pathology department along with a top notch surgeon that gets enough of a sample. We often just think of the surgeon but overlook pathology.
I'm not sure but if it were me i would be looking into that third TURB by a third opinion top center like Cleveland or Hopkins or Memorial Sloan. But thats me and you have to be comfortable with what you've chosen but you don't have to be obligated to your present institution. They understand second and third opinions.
I hope i'm not being negative here...i don't mean to be. Yours seems to be a complicated case and i just truly want you to have the best care.
Pat

John,

Yes, it is normal. The pathology doc's like to hedge their bets it seems. I had quite a lot of "cannot be ruled out" comments for many of my pathology samples.

While it may get a bit depressing, you seem to be doing the right things.
Good luck at your next TUR! If muscle invasion is ruled out you are in much better shape. However, even if it winds up being invasive, all is not lost. Many of us here have had invasive, got an RC and are doing just fine.

Mike

Thank you Pat, Jack, and Mike.

Yes, the 2nd report is from UPMC

I believe that my first TURB was just to collect samples, as my first Dr. felt that the bladder was not salvageable, and most of the tumors were still present at the 2nd TURB.

I am scheduled for a 3rd TURB on April 20 at UPMC

I see that some things are in the report are definite, and confirmed by a 2nd Dr., and some are suspicious. Is this normal in these reports?

Thanks for helping with my education, I am starting to understand some of this, but I find much of this a bit depressing. Head in the sand feels better, but I am guessing that educated choices will get a better result.

John

Wow..there's a lot going on in there! Here's a couple of things to read
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7XMT-4TG2956-1D&_user=10&_coverDate=11%2F30%2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=29679&_sort=v&_docanchor=&view=c&_ct=200&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=56934d1c14d7635802b2c7dc1020e0d1
The second one shows the Urothelial involving Von Brunns Nests...Just hit any of the categories to read about each one.
webpathology.com/case.asp?case=57
The second path report came from the U. of Pitts right?
Pat