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Thursday, July 31, 2014
Urinary Tract Cancers
Cystectomy, negative for malignancy
Dear Doctor, Please kindly review the following facts and respond to the questions at the end: 1. Cystoscopy revealed a large bladder tumour on the left side just inside the bladder neck and close to the left ureteric orifice. 2. 1st TURBT resulted in: Bladder tumour-High grade papillary urotherial carcinoma. Tumour infiltrated into underlying muscularis propria. 3. 2nd TURBT result was: Residual high grade urothelial carcinoma, which is found in the lamina propria but not in muscle. 4. 6 BCG treatments. 5. 2 cystoscopies done afterwards were negative for malignancy. 6. Finally, a biopsy was taken during a cystoscopy and it showed that the tumour was still present. 7. Radical cystectomy was done in a month after the biopsy. The post-op surgical pathology report says: "Urinary Bladder: Extensive ulceration, acute and chronic inflamation and granulomatous inflamation and fibrosis. NEGATIVE FOR UROTHELIAL DYSPLASIA AND MALIGNANCY". Is it likely that one of the biopsies was in error - no cancer found in the bladder in the post-operative biopsy compared to the previous biopsy? Is it possible for the biopsy to be positive with no cancer present? Do you think the biopsy result was a good reason to consider removing the bladder and prostate? Would it have been a good choice to leave the bladder in place and do frequent check-ups (TURBS) to extend the quality of life? Thank you.
Given the description of the events I would agree that cystectomy was the appropriate therapy for you. Though the last biopsy was positive it is very possible that the procedure itself removed the final remnants of malignancy. It is well recognized that of patients undergoing cystectomy approximately 5% will be found to have no evidence of disease on the final pathological specimen. This results as in your situation because the biopsy itself removed all the tumor and there is no means to know this. It is also recognized that the small group of patients who are tumor free at time of cystectomy have the best outcome when compared to all patients having the procedure.
I hope this information is helpful to you.
Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University