The pathology report was a huge disappointment late yesterday. The biopsy showed a more aggressive cancer although it is not yet invasive. So big decisions have to be made. One option is to go back in and take out all remnants of tumor. One is very near the kidney duct and a temporary stint would have to inserted in the duct. This causes pain and irritation. Then do another round of the BCG treatments and cross our fingers, since that didn't work last time. In the meantime the cancer can become invasive and if it gets to the lymph nodes, not treatable. The other option is remove the bladder before the cancer travels. There are two ways to go with this. One is an exterior drain and bag. This can hard on the kidneys over the years. The other is to fashion a replacement pouch out of a section of small intestine. This is risky to the intestines and would require a much longer hospitilization and recovery. But urination would be somewhat normal if it all goes well.
Bill is being referred to UC San Francisco Urology Department and will see a urological oncologist there to discuss the next step. We do not yet have that appointment. In the meantime he is feeling relatively okay, up and about taking walks.