My dad has invasive bladder cancer, but I'm confused

He's had surgery to remove a tumor in his bladder, originally thought to be a clot. Then, six weeks later (2 weeks ago) he had a biopsy. The urologist said that they had found aggressive cancer in 3 of the 5 spots they biopsied. He referred him to the uro-oncologist.

Today, this doctor told him he wants to do a more invasive biopsy this coming Wednesday and he's concerned that this is a very aggressive invasive cancer and that it may have spread to the lymph nodes and the kidneys. If this is the case, he apparently said, the prognosis is no more than 6 months.

Now, I am not looking for medical advice. But what confuses me is a couple of things. First of all, while my dad is fluent in English, my mom is not (though she understands it fairly well). I am concerned that there is a language barrier (especially when there's this type of news involved) and they may not have understood the doctor well. Secondly, the cancer was a stage II initially. According to my research, this is still a curable cancer. So why all the dire news?

Thirdly, they cannot do a removal and reconstruction of the bladder because my dad is too big and he would need to lose at least 45 lbs.

I am concerned because he's just 60. He's a dual US/Italian citizen and, when he retires, he will receive a small pension from Italy and a small Social Security check from the U.S. My mom has never worked, so there won't be much for her. His employer provided health insurance is good but they are still responsible for 20% of the bills. He's still too young to retire.

Even then, when they calculated the pension, they will be returning to Italy, because they will never be able to afford remaining in the U.S. with the cost of health care.

I suggested that they take out their meager 401(K) for extenuating circumstances and go to Italy for 3 months (as my dad can take a 3 month FMLA leave), staying with a relative and getting cared for there.

Anyway, right now I'm confused and rambling. Another confusion... if the situation is potentially so dire, why are they waiting till Wednesday for the more invasive biopsy? (note: they live in the Charleston, SC, area and this biopsy will be taking place at MUSC).

First, if you are concerned about a potential language barrier, is it possible for you to go to the appointment with your parents'? You could help them to understand their options.

Before I go any further, I want to be clear that I am not an MD and that I am not giving medical advice. I am trained as a cancer biologist and come from a research background, so I do understand some of the terminology and treatment options available. You really should sit down with you Dad and his oncologist and talk about these issues.

Stage II bladder cancer is invasive into the surrounding muscle of the bladder. Here is a good site with fairly easy to understand information (http://patient.cancerconsultants.com/CancerTreatment_Bladder_Cancer.aspx?LinkId=53848). Standard treatment for stage II is radical cystectomy, or complete removal of the bladder and surrounding muscles and tissue. If his cancer is still considered stage II, it is still considered treatable with surgery and chemotherapy. since you mentioned that his bladder cannot be removed due to his weight, that may be why the oncologists are being dire. Once again, I would suggest you speak with them.

If the uro-oncologists have evidence that his cancer has spread to his lymph nodes, his cancer will be considered stage III/IV. This is now considered metastatic, even if metastases have not yet been found.

I do not know if I have helped you in any way. Cancer is an absolutely dreadful disease that affects virtually everyone. I am very sorry that you are going through this. If you would like to ask me direct questions, send me a PM.

Tracy

If there is any way you could accompany your father to the doctor's visit, do so. Even people whose English is awfully good can be baffled by medical terminology, particularly in stressful situations. Do ask the doctor for a full explanation of the prognosis and treatment options. Asking for a second opinion could also be helpful. Many older folks hesitate to do so for for fear they will offend the doctor, but any doctor that easily offended is probably best avoided.

I have heard that the medical care in Italy is top-notch, but I suspect that very much depends on where one seeks it. If your relatives live in Rome or Milan, that could be an attractive option. If they live in a small town in Sicily, probably not so much.

We're from Bologna, the "red" capital of Italy, which has a top-notch system, so I'm not worried there.

As for the language barrier, I live 3 hours north of Charleston so being there for an appointment would be somewhat difficult (I also have few days off left).

You might be able to look into that. :)

Best of luck to your family :hug: