Waiting for important operation, but just got cancer diagnosis

[LimitedMedicalKnowledge]

My elderly parent has been having pre op consultations, and is just waiting for a date to have a knee operation. They’ve done all the prep, and we expect them to be given the nod very soon. My parent can’t even walk to the shop now so it’s quite urgent.

However we have a massive spanner in the works. My parent has had blood in their urine for 8 months. They got fobbed off for a while, then took it seriously a couple of months ago and had some tests. They’ve found a number of polyps in the bladder and they’ve said they are cancerous and need to be removed ASAP. We have a letter confirming this and they’ve done the pre op blood tests etc. It is a day visit, under general anaesthetic.

We are all very upset about the above of course. I’m worried about my parents wellbeing as if they can’t walk, their quality of life will be awful. That will just be too much for them, they’ve been very very active all their life. Their life has been/ is sport.

Can anyone advise or give me some idea of what we should do? It’s 2 different hospitals and my parent will be so devastated if they can’t sort out their knee. Obviously my main concern is the other diagnosis, but their knee is quite desperate both for their physical and MH.

I think we need a “plan of action” so we can help them, but don’t know how we should be handling this as we are upset and don’t know what we are doing.

The two teams need to discuss what to do with each other. The bladder surgery may be a minor enough procedure (if day surgery) that it can be done without too much delay to the knee surgery. If bladder surgery and treatment after requires mobility for optimal healing, there may be a case to be made for doing knee first. It very much depends on how mobility is impacted. They certainly wanted me up and moving about after my cancer surgery, but mine was probably more involved 4 days in HDU after and a long recovery.

But the doctors need to talk to each other and advise you. I’d want to know what the likely bladder cancer treatment plan was. Many cancer drugs can affect wound healing and they may want to get surgery out of the way before starting. How urgent it was to start would be a deciding factor for me.

Very good points above. I'd add that it may also depend on the grade (not stage) of the cancer. If it's an aggressive one, I'd prioritise that as waiting for a knee op and recovery might be too long.

It's a bit of a worry that your parent has had blood in urine for 8 months!

He was told that he had too high a dose of blood thinners which caused the blood in urine. The dosage was reduced and it went away, but then came back.

Is he having a TURBT and how old is he?

I think so. I've not seen the letter. My parent is 90 but not your average 90 year old. They used to be an athlete (hence the wrecked knee) and are very fit and active. Not being able to go out and do any exercise has really affected their MH.

Put it this way, no matter how bad the bladder diagnosis is, not being able to walk will be the downfall of my parent. They will be strong enough to deal with the treatment if they can get up and walk about.

Get both done - particularly knee given how awful it is for his quality of life
bladder cancer polyps are usually very slow growing (unless you’ve been told otherwise!)

I can see how distressing this is for you all. I'll tell you our experience, which I don't think you'll like.

DH was due to have major heart surgery at a London hospital. He had the pre-op and was waiting for a date. While waiting he had some prostate issues, and the scan showed up an area of concern. I'm afraid the cardiac surgeon put the heart surgery on hold, as he said any urology procedure was riddled with infection risks.

The urology waiting list was 9 months, and they wouldn't budge. That's now been done, and he's back on the cardiac list. The whole process has taken nearly two years.

I hope your parent has a better experience.

Does he need chemotherapy? I think that’s going to be the hinge point. The bladder surgery sounds straight forward day case so imagine speedy recovery but if he needs chemotherapy afterwards that will knock on to when he’s able to have the knee surgery due to infection risk.

Ultimately you need the urologist to inform the orthopaedic surgeon of their plan, then the orthopods can discuss with your father about when his knee op should take place. You can’t make a plan without all the info and they say so of the surgeons!

My son desperately needed bowel surgery to the point he couldn't be discharged without it but after his cancer came back (the week he was due to have the surgery), they outright refused to do it until after treatment for 2 reasons. The first reason was the fact that his cancer was so aggressive, he needed to start treatment ASAP and not doing that would risk less favourable outcomes and the second reason was due to infection risk.

He went through chemotherapy for 3 months and then it was another 2 months before they were happy to do his surgery so 5 months in total before it finally happened.

I think the only way it may be different is if the cancer is low grade rather than high grade so slow growing and less aggressive. High grade and aggressive cancers can't wait.

Thank you so so much. The family are all very upset, and not thinking straight, so I want to be the person who gets the facts right and structure out a plan through this.

I really, really do appreciate your help.

From what I know they’ve got a few malignant polyps and the CT scan said the urethra and prostrate looked healthy. So, I think it’s contained. It’s a day surgery in morning, out early evening.

It’s such a stressful time, and your father is lucky to have such caring and attentive family. It sounds like the cancer op will happen quickly and if no further treatment needed then hopefully it won’t knock on to the knee surgery.

@LimitedMedicalKnowledgeI’ve DM’d you x