Area of red spots discovered in cystoscopy

I have had pain in my bladder for a while. My urine analysis (3 of them) have been off and now we did a cystoscopy and there was no tumor but a very clear area at the bottom of the bladder that was covered in red spots. I am scheduled to have another cystoscopy on Monday (this time full anesthesia) to get a biopsy. No tumor just that area of red spots which are very discernable. Can this be cancer?

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First of all, welcome to BCAN! I'm sorry you have a reason for being here.

I am no doctor, but could this be carcinoma in situ? (Commonly known as CIS.) From what little I know about CIS, it can have that type of appearance.
You might want to do some research on your own, but there are surely other possibilities for this irritation besides cancer. Please let us know what you find out. We are here to help and support you!

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Thats what I am afraid of. I should mention that I smoke which is a big risk factor plus I have been taking medication for epilepsy for 38 years. The one I took for most of my life also has a high cancer risk. I found out because I had a kidney stone and they started looking into it. The urine analysis wasn't right. My calcium levels are too high. My citric acids couldn't be raised so they started looking further. I have been telling them that my bladder feels sore for the past couple of months too so they did the cystoscopy. Well I guess I have to wait till Monday when they can have a better look. I know something is really wrong as I am loosing alot of weight. To the tune of 8 lbs in 17 days. I guess nothing can be said until I get the results from the biopsy right? Is CIS always the invasive kind or can it be one of the other two?

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Also not a urologist, but I think redness of the bladder mucosa can have a number of causes, including CIS. Your biopsies will be critical in helping to sort out the cause of your red spots. I hope they turn out to be something else.

jj

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Welcome to BCAN and please ask any questions you would like. The people on this site are some of the most helpful and knowledgeable you will find. From your description, it sounds like it could be CIS (carcinoma in situ). My husband was diagnosed with CIS as well as having had a Stage 1, Grade 3 tumor. Most doctors describe CIS as being a patchy area on the bladder that looks like red velvet or has a moss like appearance. This was the case with my husband. If your pathology report comes back as CIS, please make sure to get a second opinion at a major cancer center. It is of utmost importance as bladder cancer needs to be treated at a cancer center and not at the local urologist. Please let us know the outcome of your pathology report. Good luck.

Suzie

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CIS by definition is not invasive, however as a high grade lesion it is considered high risk and left untreated or ineffectually treated can lead to invasive disease. Because of this possibility it is usually aggressively treated, most often with BCG (bacillus Calmette Guerin) an attenuated from of bacteria similar to the one that causes TB, instilled into the bladder on a repeated scheduled basis. The waiting and wondering can be quite difficult, but if you can it is probably best to let things take their course and occupy yourself with other things as much as possible until you get your biopsy and pathology. Once that is in, your doctor will be able to advise you as to what, if any, steps should be next.

jj

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I just looked at a picture of CIS online and that's exactely what it looked like on the monitore. Oh man that can't be good. So it's ok if the urologist takes the biopsy right and if it is CIS then I go to a cancer center right? I will be going to NYU as my neurologist is on staff there an doctors won't touch me unless they have his clearance because of my epilpesy. Does anyone have an opinion on NYU?

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I have never been to NYU, but it is a good starting point. You want a large medical center, preferably a major cancer center to manage these results like Sloan Kettering or the like. Definetly get a second opinon or even a third to be sure of what you are dealing with.

Good luck and God bless

Stan

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The second opinion should come from an oncologist right? There is no point going to another urologist if the biopsy comes back as CIS. If the biopsy does not come back as carcinoma would you still get a second opinion or is the biopsy good enough?

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Usually, although not always, CIS of the bladder is treated either by urologic oncologists or urologists. Medical oncologists often become involved in the treatment of more advanced cases of bladder cancer. I think if the biopsy is not CIS and not dysplasia or in some way equivocal about the presence of CIS or dysplasia I would be satisfied, if the urologist then has a satisfactory explanation of the cystoscopic findings. I know that NYU has an excellent neurology program, particularly for seizure disorders, but don't know of their depth in urologic oncology. That doesn't mean they don't, just that I am not aware.

jj

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HI bajou, I don't know. But 18 months ago, I had 5 areas of redness that they were certain were reccurence. So they did a turbt, treated me with mmc, and 7 days later the pathology report said they were not cancer. So don't jump to conclusions, see what the path tells you

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Thank you nancy..I got to remember to just wait and see. There is nothing to be done now anyway. It just sucks cause we have been searching for a month why my urine is off and if it is the Zonegran I take for epilepsy but then the weight loss got them worried. I also had a really really bad heartbreak so for all i know its from that but I am eating like a piggy. I do have metabolic acidosis that's established so that could be a factor in the weight loss. I am just tired of waiting but I guess that won't matter so I just will have to sit my tush down and chill out. Thank you all so very very much for your words of wisdom, you support and your kindness. I will wait till I know what I am dealing with before I keep on going crazy. To all of you .... I send you my love and most positive vibes because if I start praying now after 25 years of not doing that lightning would probably strike me and that can't be good for the bladder. Loads of love via my keyboard to you all.

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If for some reason you need to find another major bladder cancer hospital, urologist, or oncologist in your area just let us know. We have members all over the country and beyond. It still may be something else, but If it does turn out to be cancer you need to seek out the very best care you can possibly get! I realize there are special limitations because of other medical issues.

I know it is very difficult to wait for test results. Please feel free to vent, rage, or ask about anything. That's what we are here for and no one understands better than we do!

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Welcome to BCAN! I'm sorry you have a reason for being here.

Carcinoma in situ (CIS) is usually described as a red velvety patchy area. It can exist on its own or with other tumors. Your biopsies will be critical in helping to sort out the cause of your red spots. I hope they turn out to be something else. CIS by definition is not invasive. However, it is high grade lesion. CIS can be treated with a live virus (BCG) instilled into the bladder. However, CIS often returns and can morph into invasive bladder cancer.
At this point it is all speculation until you have the biopsy results. I would send the very tissue biopsied to Memorial Sloan Kettering (MSK). They are one of the top cancer centers in the world for bladder cancer. So, I would want a Sloan pathologist looking at my tissue.
You asked about NYU. They are good but don’t see nowhere the volume of BC that MSK does.
You asked whether the 2nd opinion should come from an oncologist. As I mentioned above, you should send you biopsy slides (the tissue) to MSK. The 2nd opinion would come from a pathologist. This way, you would get a 2nd opinion whether it is determined to be cancer or not by the first doctor. My wife had CIS of the uterus, which is a totally different disease. It was found on a sonogram by an NYU dr in the form of a polyp. The polyp was removed and NYU pathology said it was pre-cancer. We sent the slides to MSK, and the pathologist found cancer foci (the very beginning of cancer).
That all said, the red spots can be dysplasia and not cancer. However, CIS is insidious and can turn to something bad. So you are doing the right thing by getting the biopsy, but I would follow it up at MSK being that you are right here in the tri-state area.

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I know how you feel it is a whirlwind of fear. But try to stay in the moment. Hopefully all it will be is bladder irritation. But if it is something more all the wonderful people on this site will help you in many ways. Another great uro oncologist is the one I have and his name is Dr. James Mckiernan at Columbia Presbyterian Hospital. Breathe / and ask as many questions as you need to.
It is hard to stay out of those dark places in our heads. Good wishes and positive vibes through the keyboard back to you.

Sandi

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I am assuming that this is your first diagnosis of BC---and that you have not had any BCG treatments.
However, if I have mis read---and you have had BCG instillations and had bladder irritation---your redness may very well be as a result of the BCG treatments.

I just returned from a biopsy procedure that occured because of a cysto I had done last week. The Uro observed red "spotches" (no papillary tumor development--recurrance) during the cysto and wanted today's biopsy to make sure it was BCG imflammation (which I've had before) and not the development of CIS (which I have never had).
A visit with the Uro following today's procedure indicated he thinks the path will be negative and that it's BCG inflammation---(what I'm obviously hoping for).
These BCG treatments can really be a pain---I hate them--but they seem to be working for me---initial TURB 12/2009 and not a recurrance since (trusting this next path report is negative)
Dave

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I too had red spots which were shown to be a reaction to BCG and not cancer. I know you have not had BCG. Therefore, I was wondering if Nancynurse who replied also had BCG or if her red spots were caused by something else. If her red spots were not BCG related, that could indicate other reasons for red spots. But I agree with everyone else to get the pathology slides to MSK just too be certain. I am hoping that something else is causing your red spots.

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sandd
"good" to hear that your spots were BCG inflammation--I am thinking (hoping) mine are too.
Has the BCG treatments been hard for you? (they sure have for me). IF mine are CIS per the pathology--I'll be at square one on BCG treatment--starting over---I don't know if I could handle that. As it is--I'm at six month intervals for maintenance at 1/3 doses taken 3 consecutive weeks--and I still hate 'em.
IF I can make my next maintenance in June and then December---without a recurrance between now and next Dec--I am either then done with BCG--OR--maybe down to one maintenance round per year for a few years.
Can't tell you how happy I WILL be when I get a late 2011 "all clear" on that scheduled cysto

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Bajou,
I can't really add anything to all of the posts you have already gotten, but I did want to welcome you to BCAN and tell you that I am crossing my fingers that it is something other than cancer, easy to treat and soon you will be back to normal. However, if it isn't we will be here to lean on if you need us.
Cheryl

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Love your sense of humor, but the old boy welcomes back the lost without repercussions. If that is something you think might be helpful use it!! Keep us in the loop as you learn what is going on.

nn

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PS since i quit holding my laptop in my lap 6 hrs a day, no more red spots.

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