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Actos Side Effects:  When applied to TCC, the term “superficial” can be misleading, and some doctors would like to see the term discontinued. Many people equate the term “superficial” with “not very risky,” which isn’t always the case. In general, superficial TCC at the low or intermediate risk levels is a highly treatable form of bladder cancer with a good chance for an excellent outcome despite a moderate to high rate of recurrence (depending on the extent and nature of the tumor). But as we discussed in Chapter 3, some superficial TCCs are considered high risk and cariy an elevated chance that the cancer will not onfy recur, but may have progressed to a more dangerous stage when it does recur.

Luckily, only about 20 percent of those who experience a recurrence are diagnosed with a more advanced type of bladder cancer. What this means is that “superficial” bladder cancer, if and when if recurs, will usually come back again as a superficial cancer that can be managed by local means. However/ understanding your prognosis and being informed about the cancer’s possibility of recurrence are important parts of your overall treatment process.

Make sure that your multidisciplinary team – which may include your urologist, oncologist, pathologist, and radiation oncologist – welcomes your active involvement in your treatment plan and thoroughly explains each step of the process to you. It is worth mentioning that noninvasive bladder cancer is usually managed by a urologist with support from the pathologist and usually does not require a full multidisciplinary team unless it recurs repeatedly.

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Most likely at this point you’ve undergone some of the diagnostic tests discussed in Chapter 2.YouVe had tissue biopsied and classified as superficial TCC, and you probably underwent a flexible cystoscopy, during which your doctor thoroughly examined your bladder wall and made a “map” of the location of abnormal tissue or tumors that other diagnostic tests have confirmed. Sometimes more than one tumor will be present in the bladder, so your urologist will be veiy careful to look at the whole organ from the inside. The next step for you is likely to be resection (removal of the tumor), unless youVe already had a surgical biopsy or rigid cystoscopy. In that case, your doctor may have done a resection to avoid your having to undergo a second surgical procedure under anesthesia.

Undergoing a resection sounds more intimidating than it actually is. Think of it as the removal of the piece of the bladder where the tumor or abnormal cells are growing. This may effectively clear the bladder of tumor, bringing it to a state where only healthy tissue remains. When you have a bladder resection by means of a cystoscopy, as opposed to invasive surgery, you won’t have an incision or stitches, as no external cutting or incision is required.

Resecting (sometimes called endoscopic resection) is performed under general anesthesia in a hospital setting. Your doctor will use a resectoscope, which resembles a somewhat larger cystoscope. Like a cystoscope, it has a lighted lens and is introduced into your bladder through your urethra. (Don’t worry; you’ll be asleep under anesthesia and receiving pain medication while this is happening.)

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Your doctor will fill your bladder with water or a nonirritating clear liquid such as glycine, which expands the bladder walls and makes it easier to see tumors and abnormalities. Guided by the map made during the initial cystoscopy your doctor will use a small wire loop (through which a high-energy electrical current runs) to remove the cancer, a margin of healthy tissue, and a small amount of muscle. Any remaining cells are removed with an electric current or sometimes a high-powered laser. Sometimes your doctor will also take a few random tissue samples from other areas of your bladder to make sure that abnormal cells aren’t developing elsewhere. The tumor, healthy tissue, and muscle are then sent to your pathologist for examination. A small amount of muscle tissue is included in the tissue sample so that the pathologist can make sure the tumor hasn’t spread into the muscle wall. A margin of healthy tissue is taken to help decrease the chances that abnormal cells remain in the bladder.

Resection is usually carried out as outpatient surgery. This means that you probably will be able to go home the same day. (You’ll need to bring a driver with you as you’ll still be recovering from anesthesia and won’t be sufficiently alert to drive a car.) You may have some blood in your urine for a few days after a resection, and you may experience pain or stinging upon urination. The stinging urination can be eased by drinking lots of fluids and by taking simple pain medications prescribed by your urologist. If either condition lingers longer than two or three days, if other painful conditions occur, or if the bleeding becomes extensive, call your doctor right away.

In some circumstances, your doctor may choose to insert a catheter into your bladder for a short time (usually only one to two days) after the surgery, to prevent blood clots from obstructing the flow of urine and causing discomfort. The catheter allows blood and urine to gently drain out of the bladder and also allows your doctor to irrigate your bladder to promote complete healing of the resected area. On rare occasions, doctors will recommend another resection procedure. Sometimes the pathologist wants to biopsy muscle tissue from deeper in the bladder wall. And sometimes the tumor is too large to be safely removed all at once.

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