papillary carcinoma:
http://cancerweb.ncl.ac.uk/cgi-bin/omd?papillary+carcinoma

A malignant neoplasm characterised by the formation of numerous, irregular, finger-like projections of fibrous stroma that is covered with a surface layer of neoplastic epithelial cells.

neoplasm:
New and abnormal growth of tissue, which may be benign or cancerous.

webpathology.com/digital_atlas | bladder images

Here are two images of benign urothelial cells.

First a ‘tidy’ set of layers forming the urothelium.

Urothelium normally consists of 4 to 6 layers of cells. The uppermost layer consists of umbrella cells (not well seen in this image) which may have irregular hyperchromatic nuclei.

Second a more disparate set.

The urothelial cells are somewhat disorganized in this example, however, they are still clearly benign. The lamina propria (the pale area) is edematous (swollen with fluid); probably a symptom of the scattered inflammatory cells (pink).

The next image is one from the urinary cytology test I had in June 2008

The report on this is: A papillary group of cells, which I would regard as highly suspicious of well-differentiated papillary transitional cell carcinoma’ Dr N J Robertson. Derriford Hospital, Plymouth.

This is an enlargement of the above highlighting some cells

20th June 09:30
Yesterday I spoke to Dr M as I gathered she had the results of the cytology tests. Two of the three ’showed indications of transitional cell carcinoma’.

Draft ideas to present to ‘Statutory Health Professionals’

How significant is the indication is that either the haematuria has stopped or just about so?

The first issue is that I wasn’t able to monitor events earlier as a) I wasn’t aware that there could have been a problem for possibly six months prior to the obvious; b) once there was a visual indication I thought the first two instances could just be anomalies from strain; and c) when I did approach the GP she was against my self-monitoring.

I see no reason why people should be discouraged from self monitoring, and the cost of 10p per week can hardly be a legitimate reason not to object. Urine testing can expose a substantial range of metabolic imbalances or abnormalities. Once a person finds an anomaly they could then monitor daily. On approaching a GP for assistance then everything possible should be done to help the ‘patient’ (bad word) investigate and or monitor their condition.

As far as my personal condition goes, I’m waiting at least until the end of the month so I can show a months results of little or no haematuria. That there is some, is only notable as I have testing sticks indicating that, which would otherwise go unnoticed to the unaided eye.

Without the test sticks I would have no idea of what is going on.

My ‘worry’ now is not that I may have any obvious haematuria indicating a continued or increased physiological damage, but that even a few cells could indicate an unwanted turn of events. I haven’t found data on urine samples in either a haematuric or a ‘clean urine’ situation.

At least the data I am gathering may be of some use even if the situation deteriorates.

I have created a graph, spanning 3 months with a backward projection indicating the level of haematuria for fortnightly periods. Both exponential and logarithmic trends are optimistic.

However I can see the reluctance of any GP to be unimpressed, and for their professional standing would like to have further information via cystoscopy. Their requirement to maintain a professional standing does not necessarily equate to the best procedure, just the commonly accepted one.

I am not a slave to the health professionals and their insistence on an invasive procedure is largely authoritarian. Until their desire to investigate equates to mine their use of “we need to get to the bottom of this'’ or “this doesn’t help us” is just bullying. There is no ‘we’ or ‘us’ in present situation. I am gathering information so I can acquaint myself with my body. Without a satisfactory and common knowledge there can be no agreement on what action would enhance this diagnosis.

Statistical evidence is the method by which common procedure are agreed, and yet I see no evidence that my analysis is spurious to the investigation. Only further monitoring and evidence would provide enough statistics to show that such an investigative method would be useful in diagnosis.

On the graph below, apart from the obvious and substantially progressive decline, the notable points are:

1. The red horizontal line indicates the theoretical maximum that the urine testing sticks can define, at approx 200 cells/µlt
2. At 300 cells/µlt the blood may be visible??
3. The blue mark and blue hatched area is an estimate of the average for the two week period before I acquired the testing sticks. The figure if anything is more likely to be on the low side.
4. Exponential projections would never reach zero, and the logarithmic projection indicates complete cessation at the beginning of June, which is much the case.

From: cancerbackup.org.uk

” Transitional cell carcinoma is the commonest type of bladder cancer.

Doctors describe cancers according to where in the body they occur and what type of cells they have started from. Most cancers of the bladder start from the lining tissue inside the bladder. The lining of the bladder and other parts of the urinary system are made up of transitional cells. These cells aren’t normally found anywhere else in the body.

Although transitional cell carcinoma most commonly affects the bladder, occasionally it may start in the ureter, the tube joining the kidney to the bladder, or the part of the kidney that is closest to the ureter. “

The cystoscopy procedure I have rejected.

Let me clarify that the main reason is my fear of discomfort.

The procedure entails inserting a narrow inspection device into the urethra, i.e. up the penis in my case, to look at the sides of the channel, and then up into the bladder to inspect the lining.

At my recent visit to the haematology clinic, I asked the surgeon, Dr Hammond, what would he be looking for. Polyps he replied. Sounds like some sort of seaweed or mollusc, I thought, but asked what they are. Small tumours reply. And what will happen I leave them? They will grow you will have lots of pain and bleed profusely. I asked if they could just go away or is there any other way to get rid of them other that to cut them out via the cystoscopy. The answer was that there’s no record of them disappearing without surgery.

Ok I said, as I don’t want to be operated upon then I see no reason for the inspection. He offered a general anaesthetic but I pointed out the risk of damaged or death from barbiturates etc. was to avoid more than the cystoscopy.

Here are some of the vulnerabilities I have.

• Feeling emotionally, weak as I couldn’t exactly do much when it is going on or should I say in
• The thing breaking inside my dick or bladder.
• The probe is likely to cause some disturbance to the flesh which will result in possible bleeding and discomfort.
• I don’t take well to self inflicted discomfort so I will get tense and hence have less ability to self-heal

That said, if, after doing my own urine tests, I am of the opinion things are not stable or improving, I will be more include to undertake the manoeuvre.

Next is get some info and provide links to this procedure. Keywords: polyps, cystoscopy, transitional ???? something Dr M said.