thoughts

with high grade TA bladder cancer. The course of treatment is BCG 6 treatments and then wait 6 weeks for a second TURBT
does that sound reasonable.

Non invasive cancer

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When I was originally diagnosed in Dec. 2010, following my first turbt the previous November, I was staged as T1 High grade with suspected CIS. At that time I did undergo another turbt in 6 weeks for restaging purposes and I found out later that this is pretty standard procedure after an original T1 high grade diagnosis. It was not until after the 2nd turbt that I was given the 6-weeks course of BCG.

I had a recurrence in December 2011 and underwent a turbt in January. My diagnosis was TA high grade bladder cancer. In February I started the 6 weeks of BCG/Interferon intravesical treatments. A month later I had a cysto and was given an all clear. Then 3 months later I was scheduled for another cysto which I just had on July 19th.

I wouldn't be able to tell you if having BCG before a second turbt is reasonable or not and wondered if you meant a cystoscopy instead of a turbt? I have learned from the information posted on this site that there are some variations in the protocol practiced by urologist in treating bladder cancer.

Also, I would like to welcome you to BCAN!

Kathleen

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With high grade Ta, gold standard procedure (in the UK) is second TURBT straight away to check that the staging (depth) of the tumour was as originally thought. If there are any tumour cells deeper, in the muscle, then BCG is not usually appropriate, but bladder removal recommended with or without chemo. If Ta/T1 confirmed, then BCG as you describe is a reasonable option.

But do bear in mind that these tumours have a high rate of recurrence & progression to invasion. BCG does not guarantee no recurrence, the medics cannot yet predict who will do well. You risk having a new invasive tumour, then prospects are not so good. I was told that about 30% patients do well, but overall 50% end up having bladder removal. I had Ta high grade & opted to go straight for bladder removal, which has given me the peace of mind I sought.

Best wishes for your future health.

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Can you tell me how old you are, and how difficult the bladder removal was. I am getting a second opinion this morning from specialist at Stanford University. Will let you know what he says. Thanks so much for answering me, i am new to this and pretty shaken

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Glad to hear you're getting a second opinion. It is a horrid situation to be in, but I hope you can take heart from all the success stories here. None of us can ever say we're cured, but the longer we stay tumour free, the better the odds get.

I was just 57 & reasonably fit when I had my op last year, with neobladder (internal bladder replacement using a piece of small bowel, to void through the normal route). It is quite arduous surgery, both for patient & surgeon. Mine went well, without any significant problems since, but recovery does take some months. The other main option for replacing the bladder, having a urostomy (using a piece of bowel to route urine to an opening on the abdomen) & external bag, is shorter op & faster recovery. There are many here who are happy with this.

There are also those who have chosen the BCG route, which itself may have unpleasant side effects, with varying degrees of success.

If you put any specific questions as a new post, I'm sure you will get many responses. Good luck.

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Standard procedure seems to be Turb #1 with Mitomycin ;if high grade or unsure then Turb #2 inmediately after and BEFORE first 6-week BCG treatments. This was my course of treatment after Dx (TaG3) in June of of last tear. Since then I've had two 3-week BCG maintenance treatments and all clear so far... I respect Teasswil decision go the RC route but I decided that I will not give up my bladder without a fight. BCG treatments can be trying but doable. If full strenght gets to be too much, the dose can be reduced without affecting effectiveness. Talk to you Dr. and discuss your options. As for me, I will cross that bridge (RC) when I get there and if I get there. Vigilance and follow up is CRUCIAL!
First year is very hard (read my previous posts)....thinking about the next cysto or the next treatment takes a toll on you and your family, both physically and mentally. Things have gotten better for me now...this is the new normal but I've decided that no matter what the next cysto brings, I'm going to life my life as normally as I can and enjoy it to the fullest.
Good luck...

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I think that with a Ta high grade cancer bcg after 4-6 weeks with a second turbt following bcg is a common procedure, given that there is adequate evidence that muscle was not involved. To get to the muscle wall the tumor must first invade the lamina propria so in the absence of invasion (definition of Ta), not all think that a repeat turbt prior to bcg is a necessary step and initiate bcg treatment without that. There is certainly no harm, and potentially a lot to gain, by getting the second opinion you have scheduled.

jj

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thank you all for your sage advice. I got 3 opinions and all the same. The doctor took a piece of the muscle to biopsy and it is clean, there is no metastisis( spot on hip turned out to be sclerotic lesion) Saw oncologist as well. So it is 6 weeks of bcg, 4-6 weeks off and Turbt. If no cancer cells are found, then i come back in 3 more months for BCG.
Feeling more settled and relaxed and confident that i can get thru this.
Again thanks for your support

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Glad to hear all no worse than original diagnosis. Good luck with the BCG, hope it's not too unpleasant & that you have success.

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I had T 1 G 3 and my early treatment was exactly as you describe. I believe the second TURBT is to verify that the URO didn't miss anything in the first TURBT and to basically double check things. I believe that if more BC is found on the second TURBT then the induction BCG round ( the 6X round) maybe judged a failure (especially if a recurrence is seen in the same spot as the initial tumor that was removed in the first TURBT)
One other thought--be careful when reading posts--I sense that some folks get a little self oriented when making recommendations. Especially those who opted for an RC (versus trying BCG--when that was proposed as an option) They seem to advocate a RC solution (perhaps they don't want to think that maybe they should have at least tried the BCG treatment first).
Personally--I have been over 2.5 years recurrence free and have to give BCG at least some of the credit.
Another note on BCG---if you can endure the first year of instillations--it does get easier---in year two---you have a 6 month rest period--and that helps a lot to recover for the next maintenance BCG round.

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I suspect you're thinking of me - obviously one's response is coloured by one's own experience & decisions. So, I mention my history to show the context for my comments.

I do try not to make any recommendations re treatment, but make sure that people know the facts; I consider it important that people are making informed decisions but would never advocate my path as the best choice for everyone.

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I am scheduled for the first cystoscopy THREE weeks after the completion of the intitial 6 BCGs. This date will also be almost exactly 3 months from the TURBT. A second opinion also told me that the first cysto is typically 3 months after the TURBT. I am seeing much variation in what protocols the UROs are following with these time frames....I am happy to have the cysto in 3 weeks; heck, I'd have one every 2 months if that is what it takes to beat the little beast back.

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In my case--my Uro had me in for a full blown under anesthesia cysto/biopsy TEN days after my last induction BCG round (the 6th of 6). Fortunately the path from the biopsies came back no BC. I think this was too soon after the BCG. Then my first maintenance BCG round commenced three weeks after the cysto/biopsy
In retrospect--I think that was way too aggressive a schedule as my bladder was pretty beat up after that maintenance round (my first and at full strength)

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Yikes!

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I didn't feel Teasswill's comments were a recommendation only stated the path she had chosen. I honestly have to admit when I was diagnosed w/T1 - High grade - CIS I was wondering myself if it wouldn't be better to just go that route BEFORE it could become invasive. After everything I have read and the course of treatments and knowing this will be an ongoing journey for basically the rest of my life wouldn't I be better off not to "take the chance" ? But, I am starting BCG tomorrow is my first treatment. Reading the different experiences with the treatments has really helped put my mind at ease - some. The unknown is always scary but, I gotta give this a try.

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