The Plan

Diagnosed with bladder cancer in the summer of 2006, my mom underwent three cycles of BCG and/or interferon treatments before she beat it. It was a real adventure because despite bladder cancer being relatively lame (as she and I like to refer to it), my mom was very resistant to treatment. She's had three negative bladder biopsies since November 2006, the most recent of which was in June 2007, but has continued to have pain and complications.

Right-sided flank pain brought her in to see the urologist again in September. Her right kidney was four times the size of what it should be, the ureter was completely occluded, and it looked like it was cancerous. A stent was placed in an effort to dilate the ureter, allow the kidney to drain, and Dr. K was able to take another look and gather some good biopsies of the ureter this past Friday.

Which brings us to today…

This morning, she and I went to meet her primary urologist and the urosurgeon who is to perform the nephrourectomy (like that? kidney & ureter removal). The biopsy results from Friday show very aggressive cancer in her right ureter that has spread to the surrounding muscle, which is still part of the ureter. The best bet is to go ahead with the plan, and remove the kidney and ureter via laparoscopy, and then the cancerous part of the ureter, a small portion of the bladder where the ureter is attached, as well as all the surrounding lymph nodes via a larger incision between the belly button and pubic bone. This approach will make for less chance of bleeding, infection, and pain, as well as provide diagnostic and therapeutic benefits because we'll be able to tell if the cancer has spread to the lymph tissue (bad) and if it hasn't, it will never get a chance to because the nodes will be removed in that immediate area (good).

Despite the fact that bladder cancer is not supposed to spread, there is a 1-2% chance that similar cancer can pop up elsewhere in the urinary tract- further evidence that my mother is nothing less than exceptional! The chance of this moving to the other kidney or ureter is even less, and outside the urinary tract (providing it hasn't already, which is unlikely) is even less. The chance of her getting bladder cancer again is approx 50%, but she' been free and clear since Nov. 2006, with three negative biopsies since. A good sign, but she will still be monitored very closely.

The surgery is scheduled for Monday, Dec. 3. The doctors reassured us many times that doing it any sooner will not in any way impact the outcome, and this way she gets the entire day to herself, with both of their attention in the OR.

The procedure should be 5-6 hours. Recovery will be long. A few days in the hospital, a catheter and foley bag to rest the bladder and prevent bladder spasms (painful) for 1-2 weeks. Overall, no work or exercise for 4-6 weeks.

The objective now is for mom to unload as much as she can from her plate. As I said to her this afternoon- she needs to seriously embrace the stress for the next few weeks and do whatever it takes to get things settled before D day, because she's going to be unable to address anything after for quite some time.