After the Diagnosis: Treating T1 High-Grade Bladder Cancer

I was absolutely shocked by a bladder cancer diagnosis in late August 2014. Earlier the same day, my youngest daughter told me that she and her husband were finally expecting their first child. What an emotional day! Talk about 2 worlds colliding - that was it. I was elated for them, but my mind was spinning with my devastating news.

My diagnosis was clear: bladder cancer—no question about it. I had the big "C." The stage and type were still "to be determined," and that was my next step.

Determining the stage and type of bladder cancer

Transurethral resection of bladder tumor, or TURBT as it is commonly referred to, is a procedure to determine the type of bladder cancer and how advanced it is. My second TURBT revealed that my cancer was T1 high grade. Treatment options would be the next important conversation.

Treatment options for high grade bladder cancer

BCG, a treatment that is directly instilled into the bladder for a few hours, was suggested as a possible option. But due to my incontinence, it would definitely prove challenging. My ability to hold the BCG liquid in my bladder in order for it to possibly work was doubtful. Another option, which some people choose even at stage one, is radical cystectomy, or as it is commonly known, RC. This is complete bladder removal with the hope that all of the cancer is also removed. After this procedure, a diversion for urine is created. There are 3 types of diversions after RC: neobladder, Indiana pouch, and ileal conduit.

What to consider in decision-making

It was frightening to have such a major surgery, which entailed having my bladder and lymph nodes removed and a total hysterectomy. Having cancer was even scarier. The following days were spent researching the options with my current situation in the back of my mind. I had stage one high-grade bladder cancer, was unemployed, and paid 900 dollars monthly for insurance. Not a good combination. My main goal was to return to a job with health coverage as quickly as possible. Next on the urgent list was to have a top surgeon rid my body of this disease. My family and a team of doctors were the only ones who knew I had cancer, and their support was amazing. In the end, though, the decision as to my treatment was mine alone.

Deciding on the radical cystectomy and ileal conduit

I decided on radical cystectomy and ileal conduit (IC) for several reasons. The neo or IP might not work, as it was unclear if my incontinence issue was temporary or permanent. Only time would determine that, and time might not be on my side. In the end, I decided to move forward with the ileal conduit (IC) diversion option. The surgery was more common with a shorter recovery period. I was not concerned with wearing a bag at all. I had never seen one except for online pictures, but that did not bother me at all.

Meeting my surgeon

I met with my surgeon twice and discovered he was the first surgeon in NW, Ohio, to use the Davinci robotic surgical system. He was very skilled with years of experience successfully performing my specific surgery. I was confident in my choice. When I asked the doctor how long he expected my surgery to take, he said, "as long as it takes to do it perfectly." Definitely a good response!

Surgery day approached quickly

On September 30, 2014, I arrived at the hospital for the most important surgery of my life. Initially, I was scheduled for October 27, 2014. I had just accepted a job offer from my new employer, knowing that my start date was several weeks away. The following day, I received a call that a scheduled surgery for another patient had been canceled. It was an incredibly welcome relief to move my procedure date up.