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What Does This Bladder Biopsy Report Indicate?

Posted on Wed, 14 Dec 2016

Question: I have a question fro my Mom. Below are her details:

She is a 77 year old woman.
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional episodes of gross hematuria for past 5 months.

Recently she had a Bladder Biopsy (On November 1, 2016).
Below are her Biopsy Results:

***Cystoscopy with bladder biopsy with TURBT (Test done on 11/01/2016)***
A. Bladder lesion on bladder dome, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* No Muscularis propria identified
B. Bladder lesion adjacent to biopsy#1, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* Muscularis propria present and uninvolved by tumor
C. Right lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified
D. Left lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified

***Treatment Plan***
Doctor has ordered Intravesical Mitomycin treatment once a week for initial 6 weeks.
The medication will be received into a bladder by inserting a catheter into the bladder.
Treatment will start on December 7, 2016.
Treatment will end on January 11, 2017.

I have following questions:
1) How soon typically high-grade urothelial carcinima could became muscle invasive or progress to other organs?
2) She was diagnised of high-grade urothelial carcinima on November 1, 2016 and her treatment is starting on December 7, 2016.
Is it little late for high-grade carcinoma? Should we ask the doctor to start the treatment earlier?
3) What are the common risk and side-effects of Intravesical Mitomycin treatment?
4) How effective is Intravesical Mitomycin treatment for bladder cancer?

Answered by Dr. Deepak Sundriyal (1 hour later)

Brief Answer:
Hello dear. Treatment should be at the earliest

Detailed Answer:
Hello dear. I have gone through the details. I understand your concern. So its a non muscle invasive high grade carcinoma and it can rapidly invade muscle hence the treatment t is warranted at the earliest. Exact rate of invasion nobody can tell as nobody will wait to look for invasion. Intravesical mmc is a good treatment option but not free from side effects like alleegic reaction, skin toxicities and low platelets counts. The role of mmc will be to decrease the rate of recurrence by approx 10 percentage points in comparison to those who do not receive mmc.
Go ahead with the treatment.
Good luck.
Thanks and regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Deepak Sundriyal (56 minutes later)

Hello Dr. Sundriyal -

Thanks for your response.

Since my Mom had her TURBT procedure done on November 1, 2016, Dr. said he wants the bladder to rest before they start the treatment.

I am not very convinced about Dr's explanation and hence I would like to find out if there is any issue/problem to start treatment after the biopsy or do we really need to let bladder rest before the treatment starts.

Also, what will be other treatment alternatives to treat this kind of cancer which is more effective and less side-effects/risks.

Thanks again for your time and expert advice!

Best Regards

--XXXX

Answered by Dr. Deepak Sundriyal (4 hours later)

Brief Answer:
Treatment must start now

Detailed Answer:
Hello dear. I have gone through the details. So we usually start treatment after 2 weeks. So any further delay in a high grade disease is not justified.
This is the best treatment option for such tumor and go for it. Of course some side effects will occur but no escape.
Thanks and regards

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. REMY KOSHY