How is a cancerous tumor in a diverticular graded?

RC ASAP is my recommendation. Diverticula have no muscle wall. So once it grows it is automatically PT3 and can reach nodes very easily. Or worse: PT4 with growth elsewhere.

This sounds like papillary. Very often you will also find CIS.

I regret not having an annual or semiannual cystoscopy after I was diagnosed with a diverticulum in 2018.

The urologist in NC at the time emphasized it was benign and congenital.

It turns out there is an increased risk for bladder cancer because of urine stasis in diverticula.

Now I am dealing with two TURBTs, PT3AN1M0, RC, DDMVAC and now nivolumab to hopefully eradicate low MRD so there is no recurrence.

Thank you!

Were any lymph nodes removed and checked during your surgery? My husband had this done at Mayo Clinic and 1 of 29 nodes removed was positive for tumor. It was graded per those results. As a very aggressive tumor, it continued to recur in the bladder until total cystectomy was done. Recurrence was resistant to BCG and Keytruda, and he chose radical cystectomy with neobladder to try for a cure. So far so good.

Yes. PT3AN1M0 means 1 node was positive (N1). Unfortunately, that means a very high risk for recurrence. I am now on nivolumab to attempt to eradicate microscopic residual disease (MRD) is likely to recur. My adjuvant DDMVAC (4X) chemotherapy was unsuccessful in clearing the MRD.

My surgeon only removed six nodes. When I asked him why so few he responded he did an extensive resection and did not find any more.

Lymph nodes checked non cancerous so not removed.

If a node closest to diverticulum was negative then I understand why others were not removed. That reduces your chances of metastatic disease. Unfortunately the urine contained cancer cells so the bladder and urethra were exposed and microscopic lesions there can show up at a later date. That continued eruption of new "areas to watch" or actual papillary or erosive tumors is what made my husband choose radical cystectomy. I know many people live for years with constant monitoring of the bladder by cystoscopy and subsequent TURBT procedures to contain these new growths. The more aggressive the original tumor, the more likely to see rapid recurrence. Regular monitoring via cystoscopy seems like a good choice. My husband also has abdominal CTs to watch for metastatic disease per his Mayo team.

Again: tumors in a diverticulum are extremely high risk. Once they punch through the tissue they are out. There is no muscle wall.

Did you have TURBTs so far or a partial cystectomy? My general urologist suggested the latter. Good thing I insisted on a full RC. I had both papillary and CIS: even more risk.

The tumor waw contained in the diverticulum and it was all removed.

*was