Health Topics

Dealing with Recurrence

Andrew Schorr:

Let's take a call from Tommy who joins from us from Alabama. Tommy, thank you for listening. We are going to go just a couple of minutes over to bring in Tommy's call and then get some summary comments from our doctor and Tom.

Tommy from Alabama, you are on the air. What's your question?

Caller:

Well, my question is, I went through I have had five of those tumors removed, and they are called non invasive tumors. But I have just wondered maybe the last checkup was fine, and it seems like I go about a year, and then they find another one, and they remove it. And then, you know, I go in every three months, and I think it will be okay, and then one springs up again and they have to remove it. And what I was wondering now maybe like my skin seems like it's changing through the years like, you know, I am getting like moles on my skin that I used to not have and a lot of things, and I just wondered if that has anything to do with bladder cancer.

Andrew Schorr:

Well, let's find out. Dr. Dinney, any connection?

Dr. Dinney:

Yes. Your cancer obviously is coming back. It's recurrent, but luckily it's been noninvasive. The question of whether or not you would need more treatment for that cancer would depend upon the characteristics of the tumor. Oftentimes here we would give you a single dose of chemotherapy to try and reduce the frequency of the recurrences. And yours haven't been too frequent.

Now, with respect to the skin changes that you are having, I think that I don't think there is any association between that and your cancer. Do you spend a lot of time outside?

Caller:

Well, I did through the years, you know. Through the years I was out in the sun.

Dr. Dinney:

Yes. I think that's correlated to the fact that you had skin exposure and not related to your bladder cancer. I think that you should, you know, you could talk to a dermatologist there and have them take a look at some of those spots. Generally I don't think it sounds too serious, but that's what I would recommend that you do. But feel relieved that it has nothing to do with your bladder cancer.

Andrew Schorr:

Tommy, how old are you?

Caller:

I am 59 years old. I was around the paint and body business, and I was around, my doctor is from Anderson, Alabama, and I went to South Carolina to a urologist that was at Emory in Atlanta, and he has moved to Charleston, and he took over that clinic there. And I went to see him, and he told me my type cancer is the noninvasive type that was just minimal, that they were doing what they were supposed to do. And he said once they see them, it's kind of like a plowed field, and they are subject to spring up at any time. And he said if they come up, make sure you go every three months, get them checked, and if they spring up take them out immediately. And he said he was doing what he was supposed to be, so I not only went to Alabama, I went all the way to Charleston to him because I thought he was the best in our area.

Andrew Schorr:

All the best to you, and I will just put in a commercial for Dr. Dinney and his team because I went from Seattle to Houston, is if it's appropriate sometime or for other people listening might consider M. D. Anderson for a second opinion or do they have research. Again, the whole idea is if you are living with bladder cancer, and as you say they pop up some of the time, is there something that can be done, either standard therapy or maybe a clinical trial, that can lower that risk of recurrence?

Tommy, all the best to you. We are just going to go on for a couple more minutes.

Dr. Dinney, I want to get a summary comment from you. And that is you have been at this a long time, and you have a whole department there and researchers and fortunately research dollars, federal and otherwise being committed to this. Are you encouraged that even if somebody is diagnosed with bladder cancer, hopefully noninvasive like Tommy's and hopefully earlier, you can keep it at bay and you can just go on and live a long life and not have the fear of it spreading or leading to an early demise?

Dr. Dinney:

Yes. I think that for the most part that is true. And most cancers if they are detected early and are treated appropriately can be cured. Now, only a small number of individuals will present with metastatic or cancer that has spread, and while that is at the time being not a curative cancer for the most part, we are certainly making inroads in our understanding of this process where we hope that one day in the near future we are going to be able to cure those cancers.

And I think the one thing that people should keep in mind is that individuals who are involved in clinical trials have a better survival and outcome from their cancers than individuals who don't. And it just may be more careful surveillance and careful follow up and more attention to your disease, but I think that is an important component to keep in mind. Whenever possible one should get involved in a clinical trial, especially in people whose cancer is more advanced.

Andrew Schorr:

And Tom Touzel, any parting words for men and women and family members who have been touched by this diagnosis of bladder cancer to give them encouragement? You have been living pretty well post treatment. What would you say to them?

Tom:

Well, I have been very fortunate because of the intensity of my own personal disease. It is noninvasive, and although I have had a few surgeries and scopes every three months for the last four years, it's still, it is you know, people say to me, my god, you are going for another scope, or you are doing this again, and I say it's like being a diabetic. It's like checking my blood levels and glucose levels fairly often. It's a situation of management.

Andrew Schorr:

I have to share one story you told me on the phone just before we go. So your dad was a doctor.

Tom:

Yeah.

Andrew Schorr:

And you are 70 years old. This is, you know, growing up a long time ago, and you told me on the phone yesterday that he was kind of training you hoping you would become a doctor too. And those were the days when the doctor was the expert, and people always did what the doctor said and didn't ask questions. But he was encouraging you to ask questions because he thought you would be a doctor. Well, you didn't end up doing that, but you do believe in asking questions as what I like to say is a powerful patient. So is that the era we're in now? Your dad would still be proud, and asking questions leads to better care?

Tom:

I think today he would. And I can remember going on rounds with him at the hospital, and he was a pediatrician so he would visit newborn babies and their mothers in the OB ward, and when these women would ask questions he had no patience for them at all, especially if they questioned something that he told them to do. And I would discuss that with him and ask him why, you know, why he couldn't listen to them. And he actually couldn't tell me except to say that he knew best, and that they should listen.

Well, now Colin. He welcomes questions. He welcomes discussions. He doesn't talk down to me or any other patient. I mean, because I am involved with the support group there, I spend a lot of time on the floor and in the office, so I run into him. So it's easier for me to ask him a casual question, you know, on Friday morning when nobody else is around, and that I don't have to make an appointment to see him.

Andrew Schorr:

Well, I am so glad that things have changed. We are short on time, but Tom Touzel, I want to wish you all the best. You and I are going to be together soon at the big Anderson network meeting coming up early in September. Can't wait to meet you in person. And all also don't you think we ought to say to your doctor, Dr. Dinney at the think tank, merci beaucoup for joining us from Quebec?

Tom:

Certainement.

Andrew Schorr:

Very good. Dr. Dinney, thanks for being with us today and taking a break from that meeting of all those smart colleagues you have got there. We really wish you all the best, and we will see you in Houston. Okay?

Dr. Dinney:

Thank you.

Andrew Schorr:

Okay. And that is Dr. Colin Dinney and Tom Touzel. Tom, all the best to you. I'll see you in Houston.

This is what we do on Patient Power. I am so thankful to M. D. Anderson for many things. One thing is though they I think, I don't know if they cured it, but who knows, but certainly knocked my leukemia back so I get to do this. And then they sponsor these programs, and I have a great time and meet fascinating, inspiring people.

In two weeks we will do a program talking about neuropathy, the nerve effects sometimes of treatment in cancer can give people guidance. That's two weeks. As always, knowledge can be the best medicine of all. If you are going to be at the big Anderson network conference early in September, I hope to meet you in person. Thank you for joining us. I am Andrew Schorr. You have been listening to Patient Power sponsored by M. D. Anderson Cancer Center. Have a good night.

Please remember the opinions expressed on Patient Power are not necessarily the views of M. D. Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you'll get care that's most appropriate for you.