Dr. Ajit Naniksingh Kukreja
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My elder brother has undergone removal of low grade papillary carcinoma of urinary bladder without any local lymphatic involvement. He was advised to take Mitomycin C after six weeks of surgical intervention TURBT(Transurethral resection of bladder tumor). Is it necessary to go for the drug? Is it prophylactic or therapeutic? I need your valuable opinion at the earliest.
Hi,
Welcome to icliniq.com.
Superficial bladder cancer or non-muscle invasive bladder cancer includes carcinoma in situ (CIS or Tis), Ta tumors, and T1 tumors. These are all cancers that have been found very early in their development. The cancer cells are only in the lining of the innermost layer of the bladder. These type of tumors have more than five-year survival rate, but the recurrence is an issue. Multiple trials have shown intravesical instillation of BCG (Bacillus Calmette-Guerin) or Mitomycin C (MMC). This has shown progression in 7.67% of the BCG subjects and 9.44% of MMC subjects. I would suggest you go for it. I have seen patients surviving for two decades after such therapy.
Patient's Query
Hi doctor,
Thanks a lot for your opinion. My elder brother had pancreatic carcinoma about 15 years ago. He got partial resection of the pancreas, now having dilated pancreatic duct with stones. He has diabetes, which is under control now. His surgeon, who did the TURBT (Transurethral Resection of bladder tumor), advised intravesical installation of Mitomycin 60 mg weekly as chemoprophylaxis. His body weight is about 99.20 pounds. Being a medical practitioner, he has a doubt whether the advised dose is necessary for chemoprophylaxis or a lower dose would be sufficient. I would be waiting for your valuable opinion.
Hi,
Welcome back to icliniq.com.
Yes, the prescribed dose is adequate and he should go for it. Clinical trials have demonstrated the benefit of the same.
Patient's Query
Hi doctor,
My elder brother completed six doses of Mycomycin 60 mg weekly as chemoprophylaxis. After 15 days of completion of the therapy there was sudden onset of hematuria. Ultrasound shows polypoid mucosal thickenings at the posterosuperior aspect of the urinary bladder. Would you give your opinion on what he should do now?
Hi,
Welcome back to icliniq.com.
I have gone through the reports (attachment removed to protect patient identity).Polypoid mucosal thickening at the posterosuperior aspect of the urinary bladder could be due to reactionary inflammation of the mucosa. We have seen a similar effect with intravesical BCG.I would suggest you get a urine culture and if needed repeat the USG (Ultrasonography) after a week or so to see the regression in inflammation. Get back to me with the reports once done.
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Medical Gastroenterology
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