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Thursday, July 24, 2014
Urinary Tract Cancers
54 year old non-smoker in good health. Urologist found microscopic blood in urine on routine exam and growth on an ultrasound. Performed cystoscopy and visualized malignant bladder tumor - transitional cell carcinoma. Performed a TURBT. Pathology results revealed urothelial papilloma with cystitis cystica and glandularis, and focal intestinal metaplasia. Urologist told me I have a low grade tumor. Rec quarterly cystoscopies for minimum of 2 years. However, pathologist who examined slides said it is a benign inverted papilloma, not cancer and that there is virtually no risk of this recurring as malignancy. Urologist said discrepancy between his opinion and the pathologist is because pathologist never visualized tumor, only a certain amount of tissue could be recovered because of the cauterizatization. Does visualization trump pathology results?
While I understand your dilemma I favor the approach of the urologist, who after all looks after patients and is responsible for your urologic health and possibly even your life. Pathologists, in contrast, do not have patient care responsibilities, all the while providing important information for the care givers. I wish all the answers in clinical medicine always made perfect sense and that there never were any exceptions, however, that is not the case.
My suggestion to you is to obtain another urologic opinion and then decide what urologist will be responsible for your care, and then, most importantly, follow the urologist's recommendations.
R Bruce Bracken, MD
Professor of Surgery
College of Medicine
University of Cincinnati