Cancer Staging & Treatment Alternatives

While my LIFE IS NOT AT RISK, my bladder is very much at risk!

The tumors removed were substantial: One was 2cm and the other nearly as big. The pathology came back as: T1-G3. We now await pathology results on the second biopsy on May 14 to determine how aggressive the cancer is. If the cancer is growing back already, we have an aggressive case. Further treatments on the bladder (surgery, chemo, radiation, whatever) will only delay the inevitable. If you are 80 years old, these treatments can buy you plenty of time to die of something else. But if you are less than 49, these things are more akin to torture. So that’s the worst case (and lowest probability) scenario – they will have to cut out the bladder and use some spare intestinal tissue to build a new one. My mom knows 2 men that have had this done (years ago) who are living normal lives with no issues at all, so there’s not a lot of concern beyond the fact that it’s “real” surgery. So the worst case scenario has improved dramatically. Not fun, but not imminent death, either!

The more likely scenario (greater than 50% but he did not give a specific number) is to get a validation that they got it all last time, and then the chemo will kill any baby cells lurking about. But the cancer still has an 80% chance of recurrence, which the chemo will drop to 70%. I offered an opinion that 10% isn’t much, and the doctor responded that 10% is 10% and it would be stupid not to take it. It’s a good point…

After that the doctor recommends BCG treatments, a very successful form of bio-immuno-therapy. This is NOT “chemo” and NOT “radiation.” But it’s no bed of roses, either. They basically use a catheter to send in 50cc of bacteria (biotherapy) which is basically Tuberculosis bacteria (or close cousins). The catheter is removed, you go home, hold it for 2 hours, and then pee from a sitting position to avoid splashing. Then you pour bleach into the toilet, let it cook for 15 minutes, then flush. This is NASTY stuff. These bacteria love cancer cells and go hug them securely, but they ignore everything else. The body can’t tell cancer from regular cells, but it can tell bacteria cells and it does not like them, so it sends an immune response (inflammation, white blood cells, and “Natural Killer” cells) to kill the bacteria, and also the cancer – this is the immunotherapy part. It’s very much like a biological laser-guided missile. But it takes time. Side effects are irritation and flu-like symptoms that increase with each week of successive treatment, and more rarely bladder cystitis, and even more rarely you can catch TB, which is treatable but not fun at all. No patients in the doctor’s medical group have had this severe effect, and they run folks through like McDonald’s at lunchtime, so there is a decent amount of data. They have only seen and treated one case, that was transferred in from elsewhere. You wonder who dreams up these wild ideas for treatment, and the doctor had no clue.

The basic idea is that the cancer will grow back, but less and weaker each time.  The treatments thus stay ahead of it and eventually eliminate it altogether.  This theory works if the cancer grows slowly and the BCG actually works for you (not sure what the % is, but it doesn’t work for everybody.) So this fun goes on once per week for 6 weeks, then the doctor does an in-office scope (not my favorite thing, and not replaceable by any pee tests – trust me, I asked!) to see how things look. Then you do 3 weeks every 3-4 months for a year, each followed by another in-office scoping, then 3 weeks every 6 months for 2 years (plus scopings), then annual scopings for life. Yuck. I figure I will either scream like a little girl, or develop the toughest urethra in the West.