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Vakul Aren
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3367
Experience:  MBBS,DTM&H,30 years of experience
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Hi, I asked this question about 3 weeks ago about my fathers

Customer Question

Hi,
I asked this question about 3 weeks ago about my father's (88 years old) bladder cancer situation.

He had a TURBT about 11 months ago and this is his pathology report for last November's procedure:

FINAL PATHOLOGIC DIAGNOSIS:
A. BLADDER (MEDIAL TO LEFT URETERAL ORIFICE), BIOPSY:
Urothelial proliferation with mild atypia and focally papillary structure,
consistent with early low-grade papillary transitional cell carcinoma,
non-invasive (see note).
Note: Lamina propria is present and uninvolved.

B. PROSTATIC URETHRA, BIOPSY:
Denuded urothelial mucosa with chronic inflammation.
There is no evidence of malignancy.

C. BLADDER (ADJACENT TO TUMOR), BIOPSY:
Transitional cell carcinoma, grade 1-2/3, non-invasive (see note).
Note: Lamina propria is present and uninvolved.

D. BLADDER (POSTERIOR WALL SMB), BIOPSY:
Urothelial mucosa with no diagnostic abnormality recognized.

E. BLADDER, TRANSURETHRAL RESECTION:
Transitional cell carcinoma, grade 2/3, invasive of the lamina propria (see
note).

Note: Muscularis propria is present and uninvolved.

3 weeks ago the urologist found out that his cancer has recurred and he went through another TURBT last week and here is the latest pathology report:

Pathology Detail for TAO, SHIU K

MGH Surgical Pathology 10-Oct-2012 Acc# XXXXX Final

Detail:

Accession Number: S12-64823 Report Status: Final
Type: Surgical Pathology
Pathology Report: S12-64823
Massachusetts General Hospital
Boston, MA 02114 Tel (XXX) XXX-XXXX

Surgical Pathology Report


Accession #: S12-64823
Patient Name: TAO, SHIU K.
DOB: 9/17/1924 (Age: 88)
Sex: M
MRN:(NNN) NNN-NNNN
Location: Same Day Surgery Unit
Institution: MGH
Date of Operation: 10/10/2012
Date of Accession: 10/10/2012
Reported: 10/12/2012 19:15
Results To:
Niall Mercer Heney MB, MD
Alejandro Sanchez MD

FINAL PATHOLOGIC DIAGNOSIS:
A. CCT RIGHT BASE BLADDER, BIOPSY:
Detached fragments of papillary transitional cell carcinoma,
Grade 2 of 3. (See
note).

Note: One fragment of urothelial mucosa and muscularis propria with no
diagnostic abnormality recognized.


B. RIGHT WALL BLADDER, BIOPSY:
Transitional cell carcinoma in situ.

C. CCT DOME BLADDER, BIOPSY:
Papillary transitional cell carcinoma, Grade 2-3/3, non-invasive.
Transitional cell carcinoma in situ.

Note: Lamina propria but not muscularis propria is seen.

***Electronically Signed Out By Esther Oliva MD***


By his/her signature above, the pathologist listed as making the
Final Diagnosis
certifies that he/she has personally reviewed this case and confirmed or
corrected the diagnosis.


CLINICAL HISTORY
Bladder cancer.

SPECIMENS SUBMITTED:
A: BLADDER BIOPSY, CCT RIGHT BASE
B: BLADDER BIOPSY, RIGHT WALL
C: BLADDER BIOPSY,CCT DOME

GROSS DESCRIPTION
Received are 3 containers which are all labeled Shiu Tao, #297-07-12.

A. Received in formalin, labeled "CCT right base", are 2 tissue
fragments, 0.2
x 0.2 x 0.1 cm & 0.3 x 0.2 x 0.1 cm. Submitted in toto as A1.

B. Received in formalin, labeled "susp right wall", are 2 tissue
fragments,
<0.1 x <0.1 x <0.1 cm & 0.2 x 0.1 x 0.1 cm. Submitted in toto as B1. The
specimen is delicate & may not survive processing.

C. Received in formalin, labeled "CCT dome", is a 0.3 x 0.3 x
0.3 cm tissue
fragment. Submitted in toto as C1.



PART A: BLADDER BIOPSY, CCT RIGHT BASE
PART B: BLADDER BIOPSY, RIGHT WALL
PART C: BLADDER BIOPSY,CCT DOME


My questions are:

1. Is the recurrence more serious than the first finding 11 months ago?
2. Are the tumors still superficial, i.e. they have not break throughout the muscle layer?
3. The urologist suggested another cystoscopy in 3-4 months and we discussed about BCG treatment but due to my father's age, low pain threshold and mental condition, he said it's better not to have him go throughout the 6 weeks regimen.
4. Is grade 2-3 very aggressive and the progression is faster?
5. What is the meaning between carcinoma in situ?
6. For sample B there is no note or grading, is that OK?

Thanks
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Sharon Hooper replied 1 year ago.

Dr. Sharon Hooper :

Hi there, this is Dr. Hooper. I would like to answer your question


 

Expert:  Dr. Sharon Hooper replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Customer: replied 1 year ago.

Hi

Customer: replied 1 year ago.

Hello Do you need more information?

Customer: replied 1 year ago.

Hi


do you need more information?


 

Customer: replied 1 year ago.
Relist: Other.
I didn't get a repsonse after I replied twice asking the doctor what information she needs.
Expert:  Vakul Aren replied 1 year ago.

1.Recurrences are common in Transitional Cell Carcinoma(TCC) of the bladder,upto 80% will exhibit at least one recurrence. 2.The tumour appears to be superficial,non-muscle invasive TCC have a good prognosis with a 5 year survival rate of almost 85-95%.Carcinoma In Situ(CIS) as mentioned for specimen B and Cis more aggressive. 3.Regular follow ups with imaging studies and cystoscopy will help monitor and assess the progress of the malignancy.Hence cystoscopy and CT/MRI scans will need to be done on a regularly for follow up.. 4.The prognosis of TCC tends to decrease with increase in grading,higher grades like 2,3 tend to have a poorer prognosis.The survival rates tend to fall to 63%-80% with T2,T3 a 67-72% and T3 b falling to 17-57%. 5.Carcinoma in Situ is a more aggressive type of bladder cancer ,it carries a poorer prognosis. 6.Specimen B is labelled as Carcinoma in Situ.

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Category: Medical
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Experience: MBBS,DTM&H,30 years of experience
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