Friday, May 9, 2014

Carcinoma In Situ of the Bladder: Beware of this Non-Invasive Cancer

Approximately 75,000 people are diagnosed with urothelial cancer of the bladder each year.[1]  It is estimated that nearly 300,000 people are walking around right now with bladder cancer in a variety of stages.  Fortunately, most people -- approximately 70% -- have non-invasive urothelial cancers or cancers that do not invade the detrusor muscle of the bladder.[2]  In general, non-invasive urothelial cancers are, in their own right, not dangerous.  However, even non-invasive high-grade cancers can progress to invasive disease and therefore have the potential to be fatal.
Bladder Cancer Staging.

Non-invasive cancers are stratified into stage Ta (70%) or confined to the lining of the bladder (i.e. urothelium), T1 (20%) invading the lamina propria (superficial layer of the bladder) or carcinoma in situ (CIS, 10%).[2]  CIS is a high-grade urothelial malignancy that is confined to the superficial-most layers of the bladder.  Although CIS is considered a non-invasive malignancy, it should not be considered a benign or indolent cancer.

Here we review some of the data regarding CIS.

CLINICAL PRESENTATION

While many bladder cancers (13-34%) present with gross hematuria (visible blood in the urine);[3,4] CIS is notorious for presenting with irritative voiding symptoms.[5]  Upwards of 80% of patients with CIS will present with irritative voiding symptoms.[6]

RISK OF PROGRESSION

In many cancers, CIS is considered a "pre-malignant" lesion.  This is NOT true for bladder cancer.  In fact, CIS of the bladder should be thought of as a flat, high-grade cancer and a precursor to invasive disease.  This is supported by a number of studies and findings:

  • The subsequent risk of CIS to progress to muscle-invasive or metastatic urothelial cancer is 40% or greater, especially if concomitant papillary tumors are present.[7,8]  
  • Of patients who undergo cystectomy for CIS alone, upwards of 20% will be found to have invasive cancer at final pathology.[9]  
  • Patients with T1 disease who undergo cystectomy have a 6% risk of upstaging at final pathology; however patients with T1 disease and concomitant CIS have a 55% risk of upstaging.[10]
  • In a number of surgical series, CIS is one of the most important prognostic characteristics after tumor grade.[11,12]
  • 20% of patients with CIS alone will die at 10 years.[13]

MANAGEMENT OF CARCINOMA IN SITU

CIS can be difficult to manage as it cannot be resected in the same sense as a papillary tumor as CIS is often flat, difficult to visualize and multifocal.  In addition, CIS can be very difficult to find.  In patients with irritative symptoms and/or positive high-grade cytology, a number of strategies can be employed to evaluate the bladder for the presence of CIS including (1) random, cold-cup bladder biopsies or (2) fluorescence cystoscopy.

Once diagnosed, CIS is best treated with intravesical BCG (please see prior blog entries BCG For Bladder Cancer: Why it Works, How it Works and Success Rates for Intravesical BCG Treatments for Bladder Cancer).  BCG is approved by the FDA (Food & Drug Administration) for the treatment of CIS and is the preferred initial intravesical treatment for CIS according to the AUA (American Urological Association) Guideline for the Management of Nonmuscle Invasive Bladder Cancer.

  • The initial tumor-free response after induction BCG is as high as 84%.[14,15]
  • Approximately 50% of patients experience a durable response for 4 years or longer.
    • Approximately 30% of patients experience a response for 10 years.[16]

However, patients who do not respond to BCG have an incredibly high rate of progression; 95% of patients who do not respond to an induction course of BCG will progress to worse disease.[17,18]

There are a number of other chemotherapies that can be used for the treatment of CIS including adriamycin, gemcitabine and thiotepa.  In North America, BCG is used most frequently due to a higher response rate (68% complete response for CIS vs. 49% for other chemotherapies) in a number of studies.[19,20]

Many patients with CIS will be refractory to an initial course of intravesical treatment.  If first-line treatment fails, especially if the first line was chemotherapy, a second course of BCG can be given as 30-50% of patients will respond to this second course.[21,22]  More than two courses of any medication are not recommended as 80% of patients who fail two courses will fail a third, and can be a harbinger of rapidly progressive, dangerous disease.

Patients with CIS who fail BCG should strongly consider an "early" cystectomy.  While removal of the bladder for non-invasive disease can be considered drastic:

  • 50% of patients with non-muscle invasive disease will be found to have muscle-invasion at cystectomy
    • 15% of muscle-invasive cancers will have micrometastatic disease [23]
  • The long-term survival for patients with non-muscle invasive disease approaches 90%, which is significantly higher than patients with muscle-invasive cancers.[24,25]


SUMMARY


  • Carcinoma in situ (CIS) is a high-grade, flat cancer of the bladder with potentially aggressive behavior
  • The first line treatment for CIS in intravesical BCG treatment
  • Patients who do not respond to intravesical treatment should strongly consider cystectomy due to the high rates of progression to advanced disease.


For additional information regarding BCG treatments check out the following blog entries:
BCG For Bladder Cancer: Why it Works, How it Works
Success Rates for Intravesical BCG Treatments for Bladder Cancer


This blog was written by Phillip M. Pierorazio, MD, Assistant Professor of Urology and Oncology at the Brady Urological Institute at Johns Hopkins.










[1] American Cancer Society. Cancer Facts & Figures 2014. Atlanta: American Cancer Society; 2014.
[2] Ro JY, Staerkel GA, Ayala AG,et al: Cytologic and histologic features of superficial bladder cancer. Urol Clin North Am 1992; 19: 435-453
[3] Lee LW, Davis E: Gross urinary hemorrhage: a symptom, not a disease. JAMA 1953; 153: 782-784
[4] Varkarakis MJ, Gaeta J, Moore RH,et al: Superficial bladder tumor: aspects of clinical progression. Urology 1974; 4: 414-420
[5] Mohr DN, Offord KP, Owen RA,et al: Asymptomatic microhematuria and urologic disease: a population-based study. JAMA 1986; 256: 224-229
[6] Zincke H, Utz DC, Farrow GM,et al: Review of Mayo Clinic experience with carcinoma in situ. Urology 1985; 26: 39-46
[7] Donat SM. Evaluation and follow-up strategies for superficial bladder cancer. Urol Clin North Am 2003;30:765–6.
[8] Althausen AF, Prout GR, Daly JJ,et al: Non-invasive papillary carcinoma of the bladder associated with carcinoma in situ. J Urol 1976; 116: 575-580
[9] Farrow GM, Utz DC, Rife CC,et al: Morphological and clinical observations of patients with early bladder cancer treated with total cystectomy. Cancer Res 1976; 36: 2495-2501
[10] Masood S, Sriprasad S, Palmer JH,et al: T1G3 bladder cancer—indications for early cystectomy. Int Urol Nephrol 2004; 36: 41-44
[11] Koch MO, Smith JA: Natural history and surgical management of superficial bladder cancer (stages Ta/T1/Tis). In Vogelzang N, Miles BJ(eds)Comprehensive textbook of genitourinary oncology. Baltimore: Lippincott Williams & Wilkins, 1996, pp.405-415
[12] Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J,et al: Multivariate analysis of the prognostic factors of primary superficial bladder cancer. J Urol 2000; 163: 73-78
[13] Herr HW, Badalament RA, Amato DA,et al: Superficial bladder cancer treated with bacillus Calmette-Guérin: a multivariate analysis of factors affecting tumor progression. J Urol 1989; 141: 22-29
[14] Lamm DL, Blumenstein BA, Crissman JD,et al: Maintenance bacillus Calmette-Guérin immunotherapy for recurrent Ta,T1 and carcinoma in situ TCC of the bladder: a randomized SWOG study. J Urol 2000; 163: 1124-1129
[15] Lamm DL, Riggs DR, Bugaj M,et al: Prophylaxis in bladder cancer: a meta-analysis. J Urol 2000; 163: 151
[16] Herr HW, Wartinger DD, Fair WR,et al: Bacillus Calmette-Guérin therapy for superficial bladder cancer: a 10-year follow-up. J Urol 1992; 147: 1020-1023
[17] Coplen DE, Marcus MD, Myers JA,et al: Long-term follow-up of patients treated with 1 or 2, 6-week courses of intravesical bacillus Calmette-Guérin: analysis of possible predictors of response free of tumor. J Urol 1990; 144: 652-657
[18] Harland SJ, Charig CR, Highman W,et al: Outcome in carcinoma in situ of bladder treatment with intravesical bacille Calmette-Guérin. Br J Urol 1992; 70: 271
[19] O'Donnell MA: Advances in the management of superficial bladder cancer. Semin Oncol 2007; 34: 85-97
[20] Sylvester RJ, van der Meijden A, Witjes JA,et al: High-grade Ta urothelial carcinoma and carcinoma in situ of the bladder. Urology 2005; 66: 90-107
[21] Brake M, Loertzer H, Horsch R,et al: Long-term results of intravesical bacillus Calmette-Guérin therapy for stage T1 superficial bladder cancer. Urology 2000; 55: 673-678
[22] Pansadoro V, De Paula F: Intravesical bacillus Calmette-Guérin in the treatment of superficial transitional cell carcinoma of the bladder. J Urol 1987; 138: 299-301
[23] Chang SS, Cookson MS: Radical cystectomy for bladder cancer: the case for early intervention. Urol Clin North Am 2005; 32: 147-155
[24] Amling C, Thraser J, Frazier H,et al: Radical cystectomy for stages Ta, Tis, and T1 transitional cell carcinoma of the bladder. J Urol 1994; 151: 31
[25] Freeman JA, Esrig D, Stein JP,et al: Radical cystectomy for high-risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction. Cancer 1995; 76: 833-839

38 comments:

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    1. In 2016, I was diagnosed of genital herpes.. I was 31 years old and I had no idea what that was. When my doctor explained to me what Genital Herpes was all about and what type I had...I was freaked out! if I had missed coming to the ER any sooner, I would have possibly died without having the slightest clue of what led to my death, as i have never heard of, or experienced the virus before! The rashes grew and i have been living with it ever since then. Most of the time, I feel dirty knowing i was living with herpes. Though the doctor already encouraged me to keep using my medications even though there is no permanent cure for the virus. So i continued with my medications, which only makes the rashes to disappear, and reappear after some days. Late last year, I started surfing the web, seeking for herbal treatment as alternative. So i was on YouTube one evening,i stumbled upon a comment about Dr. CHUKWU MADU HERBAL HOME and how his herbal medications cured a woman's son of Herpes and I decided to reach out to him. He asked me some questions which i answered, after which He prepared some herbs and sent them to me. He then guided me on how to use them. i used the herbal medications for about ,21days. The rashes gradually dried up. So i went for a test and came back home Herpes free. So My experience with this virus made me to realize, people should find out more about themselves before it's too late. So that when tested positive, they will quickly start making use of the right medication becacause i believe when the right medication is applied, then the sickness is conquered! If you are having any sickness or virus and needs deliverance contact DR.CHUKWU MADU HERBAL HOME. (for your permanent healing) He is the right person to tell your health challenges to. You can contact the doctor via his email address :[ dr.chukwumaduherbalhome@gmail.com ]. Reach him via WhatsApp +2347030936239. Doc. CHUKWU MADU , your saved my life.

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  7. HOW I GOT CURED OF HERPES VIRUS.

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    Dr Itua Herbal Center Contact,Email: drituaherbalcenter@gmail.com Or WhatsApp:+2348149277967

    ReplyDelete
  10. I am a 51 year old female that just found out I have Motor Neuron Disease Parkinson's about a year and half, but I have been having signs of it for years, tremors, depression, body weakness. ECT. I honestly don't think my doctor was reading the signs because of my gender and age. A few years ago I had my shoulder lock up on me and I was sent to a P.T since x-rays didn't show any physical damage. My shaking was getting worse and I began falling. Only when my speech became so bad that it brought concern to my dentist was Parkinson's even considered. He phoned my doctor with his concerns about my shaking and balance problems. By this time I was forgoing shots in the back of my neck for back and neck pain to which once again I was sent to a P.T (although x-rays showed no damage) I was told I had a few spurs which were most likely causing the pain. Here I was feeling like my whole body was falling apart and doctor could not find anything wrong, maybe in was all in my head? My doctor even seemed annoyed with me and things just kept progressing and I just kept it to myself, why bother going through testing and them finding nothing? Well, it was after my second P.T called my doctor about the weakness in my legs and arms, by this time I have developed a gait in my walk and I fell more frequently. Only then did my doctor send me to a specialist and it was found that I had Parkinson's, and that I have had it for awhile. I think because I was a woman that my signs and symptoms weren't taken seriously and therefor left untreated for so long,I was taking pramipexole dihydrochloride three times daily, I Was on carbidopa levodopa but only lasted 90 minutes then wore off.I found that none of the current medications worked effective for me.I got tired of using those medication so I decided to apply natural herbs formula that was prescribed to me by my second P.T, i purchase the herbal formula from totalcureherbsfoundation. com, There has been huge progression ever since I start the treatment plan which will last for 15 weeks usage.all the symptoms and sign has begin to disappear .

    ReplyDelete
  11. In 2016, I was diagnosed of genital herpes.. I was 31 years old and I had no idea what that was. When my doctor explained to me what Genital Herpes was all about and what type I had...I was freaked out! if I had missed coming to the ER any sooner, I would have possibly died without having the slightest clue of what led to my death, as i have never heard of, or experienced the virus before! The rashes grew and i have been living with it ever since then. Most of the time, I feel dirty knowing i was living with herpes. Though the doctor already encouraged me to keep using my medications even though there is no permanent cure for the virus. So i continued with my medications, which only makes the rashes to disappear, and reappear after some days. Late last year, I started surfing the web, seeking for herbal treatment as alternative. So i was on YouTube one evening,i stumbled upon a comment about Dr. CHUKWU MADU HERBAL HOME and how his herbal medications cured a woman's son of Herpes and I decided to reach out to him. He asked me some questions which i answered, after which He prepared some herbs and sent them to me. He then guided me on how to use them. i used the herbal medications for about ,21days. The rashes gradually dried up. So i went for a test and came back home Herpes free. So My experience with this virus made me to realize, people should find out more about themselves before it's too late. So that when tested positive, they will quickly start making use of the right medication becacause i believe when the right medication is applied, then the sickness is conquered! If you are having any sickness or virus and needs deliverance contact DR.CHUKWU MADU HERBAL HOME. (for your permanent healing) He is the right person to tell your health challenges to. You can contact the doctor via his email address :[ dr.chukwumaduherbalhome@gmail.com ]. Reach him via WhatsApp +2347030936239. Doc. CHUKWU MADU , your saved my life.

    ReplyDelete
  12. Hiv disease for the last 3 years and had pain hard to eat and cough are nightmares,especially the first year At this stage, the immune system is severely weakened, and the risk of contracting opportunistic infections is much greater. However, not everyone with HIV will go on to develop AIDS. The earlier you receive treatment, the better your outcome will be.I started taking ARV to avoid early death but I had faith in God that i would be healed someday.As a Hiv patent we are advise to be taking antiretroviral treatments to reduce our chance of transmitting the virus to others , few weeks ago i came on search on the internet if i could get any information on Hiv treatment with herbal medicine, on my search i saw a testimony of someone who has been healed from Hiv her name was Achima Abelard and other Herpes Virus patent Tasha Moore also giving testimony about this same man,Called Dr Itua Herbal Center.I was moved by the testimony and i contacted him by his Email.drituaherbalcenter@gmail.com . We chatted and he send me a bottle of herbal medicine I drank it as he instructed me to.After drinking it he ask me to go for a test that how i ended my suffering life of Hiv patent,I'm cured and free of Arv Pills.I'm forever grateful to him Drituaherbalcenter.Here his contact Number +2348149277967...He assure me he can cure the following disease..Hiv,Cancer,Herpes Virus,Hpv,Pile,Weak Erection,Lyme Disease,Epilepsy,Glaucoma.,Brain Tumor,psoriasis, Cataracts,Macular degeneration,Cardiovascular disease,Chronic Diarrhea,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia. ,Bladder Cancer,Autism,Colorectal Cancer,Breast Cancer,Kidney Cancer,Leukemia,Lung Cancer,Tay tach disease,Non Hodgkin Lymphoma,Skin Cancer,Lupus,Uterine Cancer,Prostate Cancer, Seizures, fibromyalgia ,ALS,Hepatitis,Copd,Parkinson disease.Genetic disease,Fibrodysplasia disease,Fibrodysplasia Ossificans Progressiva,Fluoroquinolone Toxicity Syndrome,Stroke,Hpv,Weak Erection,Liver/Kidney Inflammatory,Men/Woman infertility, bowel disease ,Huntington's disease ,Diabetes,Fibroid.

    ReplyDelete
  13. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: Painful or Irregular Menstruation. HIV/Aids. Breast Enlargement. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Lupus.  Cancer.  Tuberculosis.  Zero sperm count.  Asthma.  Quick Ejaculation. Corneal Ulcer, Gallstone, Terminal Illnesses, Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

    ReplyDelete
  14. For years, I have read and seen the advertisements in the mass media about all of the penis enhancement pills and thought that they were all scams or gimmicks. All of the medical sites that I have visited stated that none of the herbal supplements would ever help increase the size of a penis. I got very depressed when I read this, because unfortunately I was not naturally blessed with a penis that was big enough to arouse my sexual partner or past partners. I am a man that is past my sexual primetime and my sexual performance has a lot to be desired. I decided to try Doctoc Akhigbe herbal medicine after all the reading and researching that I have done.I saw a testimony " Joe" about doctror Akhigbe Herbal Medicine Since there is a Money Back Guarantee, I give him a trial what did I have to lose? I couldn't believe the results I was seeing after drinking the Natural  Herbal Medicine  and Herbal Soap to be rubign my penis! he sent to me through DHL courier delivery service . Within about 2 weeks I had a noticeable increase in the girth of my penis. Then after a coupleof aditional week it started to grow in length and I was amazed and very excited.before I finish the drink and the soap my penis had grown an additional two inches. I've had a considerable improvement with my sex life and these pills are certainly worth every penny I spent on them! I want to thank Dr Akhigbe for the time and effort they have spent on helping people in my situation.I know many are out there who are suffering this problem and they need help, email him.    drrealakhigbe@gmail.com.    He also cure other diseases like: Painful or Irregular Menstruation. HIV/Aids. Breast Enlargement. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Lupus.  Cancer.  Tuberculosis.  Zero sperm count.  Asthma.  Quick Ejaculation. Corneal Ulcer, Gallstone, Terminal Illnesses, Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. For your cure email him now:   drrealakhigbe@gmail.com    or Contact his numbe:  +2349010754824.

    ReplyDelete
  15. My father was diagnosed with ALS in the summer of 2013; His initial symptoms were quite noticeable. He first experienced weakness in his right arm and his speech and swallowing abilities were profoundly affected. We all did our best to seek help for this disease no medications they prescribe worked ,we were all scared we might lost him due to his condition, as he had been his brother's caregiver a few years earlier for the same disease before he past. doctor recommend natural treatment from total cure herbal foundation for his ALS we have no choice to give a try on natural organic treatment ,this herbal cure has effectively reverse my father condition ,losing his balance which led to stumbling and falling stop after the completing the herbal supplement which include his weakness in his right arm and his speech, home remedies from totalcureherbsfoundation com is the best although their service is a little bit expensive but it worth it, they save lives

    ReplyDelete
  16. I am here to give my testimony about Dr Ebhota who helped me.. i want to inform the public how i was cured from (HERPES SIMPLEX VIRUS) by salami, i visited different hospital but they gave me list of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Dr Ehbota cured them. when i contacted him he gave me hope and send a Herbal medicine to me that i took for just 2 weeks and it seriously worked for me, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that there is no cure for herpes that is Not true just contact him and get cure from Dr Ebhota healing herbal cure of all kinds of sickness you may have like
    (1) CANCER,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) CANCER,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA
    (10)SIMPLEX HERPES AND GENITAL
    (11)COLD SORE
    HERPES. he also cure my friend from cervical cancer Email: drebhotasoultion@gmail.com or whatsapp him on +2348089535482

    ReplyDelete
  17. HERPES CURE IS REAL:

    Indeed Doctor Disu has a cure for Herpes Virus,
    I was once victim of the herpes virus with many epidemics on my body, I was cured of the virus thanks to the help of Doctor Disu herbal medicine. I have met most of his patient testimonials on blogs and social media pages, cured of various illnesses. I contacted him with his email address to which he replied and asked me a few questions and the preparation method for which I paid, he sent me herbal medicines and with his prescription I drank herbal medicine for 21 days and the epidemics on my body were healed after concluding herbal medicine, I went for the test and my result was negative with no trace of virus in my blood. You can also be cured, contact him on his official email; africanherbalcure@gmail.com or WhatsApp him on +2348167485904.

    He said he had an herbal remedy for
    Diabetes, cancer, PENIS ENLARGMENT,
    HIV, heart disease and liver disease
    website: https://drdisuafricanherbalcure.weebly.com

    ReplyDelete
  18. HOW I GOT CURED OF HERPES DISEASE IT IS REAL TESTIFIED
    All thanks to dr Ojiro , i have being suffering from Herpes for so long till i met a woman who told me about a particular doctor who has cured her from Herpes i didn't believe it, till i collected her number and i called her, she is an Florida woman, she told me all i need to know about this doctor and i contacted the doctor and explain my situation to him and he told me all i need to do and I'm happy to tell the whole world now that am Herpes negative, may the good lord grant you long life doctor. Ojiro If you are suffering from such illness or you have any spiritual problem, HPV, CANCER, penis enlargement, hurry up and contact dr Ojiro via email: drojiroherbalhome@gmail.com. or WhatsApp him to via:+2348109094409 i will forever be grateful.

    Dr Ojiro

    ReplyDelete
  19. HOW I GOT CURED OF HERPES DISEASE IT IS REAL TESTIFIED
    All thanks to dr Ojiro , i have being suffering from Herpes for so long till i met a woman who told me about a particular doctor who has cured her from Herpes i didn't believe it, till i collected her number and i called her, she is an Florida woman, she told me all i need to know about this doctor and i contacted the doctor and explain my situation to him and he told me all i need to do and I'm happy to tell the whole world now that am Herpes negative, may the good lord grant you long life doctor. Ojiro If you are suffering from such illness or you have any spiritual problem, HPV, CANCER, penis enlargement, hurry up and contact dr Ojiro via email: drojiroherbalhome@gmail.com. or WhatsApp him to via:+2348109094409 i will forever be grateful.

    Dr Ojiro

    ReplyDelete
  20. FINALLY FREE FROM HERPES VIRUS
    I thought my life had nothing to offer anymore because lifebecame meaningless to me because I had Herpes virus, thesymptoms became very severe and bold and made my familyrun from and abandoned me so they won't get infected. I gaveup everything, my hope, dreams,vision and job because thedoctor told me there's no cure. I consumed so many drugs butthey never cured me but hid the symptoms inside me makingit worse. I was doing some research online someday when Icame across testimonies of some people of how DR Ebhotacured them from Herpes, I never believed at first and thoughtit was a joke but later decided to contact him on the detailsprovided and when I messaged him we talked and he sent mehis herbal medicine and told me to go for a test after twoweeks. Within 7 days of medication the symptomsdisappeared and when I went for a test Lo and behold I wasNEGATIVE by the Doctor Who tested me earlier. Thank you DREbhota because I forever owe you my life and I'll keep ontelling the world about you. If you are going through samesituation worry no more and contact DR Ebhota viadrebhotasolution@gmail. com or WhatsApp him via +2348089535482.he also special on cureing 1. HIV/AIDS2. HERPES 3. CANCER 4.ALS 5. HEPATITIS B 6.DIABETES 7. HUMAN PAPILOMA VIRUS DISEASE(HPV)8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or LupusErythematosus 

    ReplyDelete
  21. FINALLY FREE FROM HERPES VIRUS
    I thought my life had nothing to offer anymore because lifebecame meaningless to me because I had Herpes virus, thesymptoms became very severe and bold and made my familyrun from and abandoned me so they won't get infected. I gaveup everything, my hope, dreams,vision and job because thedoctor told me there's no cure. I consumed so many drugs butthey never cured me but hid the symptoms inside me makingit worse. I was doing some research online someday when Icame across testimonies of some people of how DR Ebhotacured them from Herpes, I never believed at first and thoughtit was a joke but later decided to contact him on the detailsprovided and when I messaged him we talked and he sent mehis herbal medicine and told me to go for a test after twoweeks. Within 7 days of medication the symptomsdisappeared and when I went for a test Lo and behold I wasNEGATIVE by the Doctor Who tested me earlier. Thank you DREbhota because I forever owe you my life and I'll keep ontelling the world about you. If you are going through samesituation worry no more and contact DR Ebhota viadrebhotasolution@gmail. com or WhatsApp him via +2348089535482.he also special on cureing 1. HIV/AIDS2. HERPES 3. CANCER 4.ALS 5. HEPATITIS B 6.DIABETES 7. HUMAN PAPILOMA VIRUS DISEASE(HPV)8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or LupusErythematosus 

    ReplyDelete



  22. MY HIV HEALING TESTIMONY
    My mouth is short of words, i am so so happy because Dr Samuel healed me from HIV ailment which i have been suffering from the past 5years now, i have spent alot when getting drugs from the hospital to keep me healthy, i have tried all means in life to become Hiv negative one day, but there was no answer until i found Dr Samuel from the parish of Africa who provide me some healing spell and herbs that he used to help me, now i am glad telling everyone that i am now HIV Negative, i am very very happy, thank you Dr Samuel for helping me get my life back without any form of crisis, may God bless you Dr Samuel and equip you to the higher grade for healing me. i am so amazed. so i will announced to everyone in this whole world that is HIV positive to please follow my advice and get healed on time, because we all knows that HIV disease is a deadly type,contact Dr Samuel for your HIV healing spell and herbs today at: drsamuelherbalclinic27@gmail.com.... He will always be happy to assist you online and ensure you get healed on time, You can reach him through his email address which is drsamuelherbalclinic27@gmail.com or his WhatsApp line on + 2348168178485 today for your healing spell immediately, thank you sir. His website is https://dr-samuel-herbal-clinic.business.site/


    ReplyDelete
  23. I have been suffering from Herpes for the past 3 years and 8 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr odion on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i took according to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Herpes. My heart is so filled with joy. If you are suffering from Herpes or any other disease you can contact Dr Odion today on this email:drodionherbalhome12@gmail.com WhatsApp him on this Number +234 9019421176 Dr odion cures:
    1. HIV / AIDS
    2. HERPES 1/2
    3. CANCER
    4. ALS (Lou Gehrig's disease)
    5. Hepatitis B
    6. chronici pancreatic
    7. emphysema
    8. COPD (chronic obstructive pulmonary disease

    ReplyDelete
  24. i have been suffering from a deadly disease (Hsv) for the past 3 years now, I had spent a lIot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I was searching through the internet, I saw a testimony on how Dr Onokun helped someone in curing his (Hsv) herpes disease, quickly I copied his email which is Dronokunherbalcure@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days after using the herbal cure, behold I was free from the deadly disease, he only asked me to post the testimony through the whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in return. if you are having a similar problem just email him on : Dronokunherbalcure@gmail.com

    ReplyDelete
  25. i have been suffering from a deadly disease (Hsv) for the past 3 years now, I had spent a lIot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I was searching through the internet, I saw a testimony on how Dr Onokun helped someone in curing his (Hsv) herpes disease, quickly I copied his email which is Dronokunherbalcure@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days after using the herbal cure, behold I was free from the deadly disease, he only asked me to post the testimony through the whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in return. if you are having a similar problem just email him on : Dronokunherbalcure@gmail.com

    ReplyDelete
  26. I was diagnosed of herpes virus, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor called Dr Agaba, who prepare herbal medicine to cure all kind of diseases including herpes virus (Herpes), when i contacted this herbal doctor via email, he sent me herpes virus herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed i was totally cured from the virus within 3 weeks of usage. Contact this great herbal doctor today to get your cure. 
    Via Email: Dragabasolutionhome@gmail.com or WhatApp: +2349074536486    

    ReplyDelete
  27. HOW I GOT CURED FROM CANCER,I was diagnosed of Cancer and i have tried all i can to get cured but all to no avail, until i saw a post in a health forum about a herbalist man who prepare herbal medication to cure all kind of diseases including Cancer, at first i doubted if it is real but i decided to give it a try, when i contacted DR Anuge and he prepared a cancer herbal cure and sent it to me via Ups delivery company service, when i received this herbal medicine, he directed me on how to take the medicine, after taking it the way he instructed me to, i was totally cured of the deadly disease called cancer, all thanks to DR ANUGE, please you can get him contacted via email {Dranuge@gmail.com} or his WhatsApp on +2348164866838He can also cure following virus(1).HSV/1and2
    (2).Cancer
    (3).Hepatitis
    (4).Hiv/aids
    (5).Pcos
    (6).Fibroid
    (7).Hpv
    (8).Diabetes.

    ReplyDelete
  28. HOW I GOT CURED FROM CANCER,I was diagnosed of Cancer and i have tried all i can to get cured but all to no avail, until i saw a post in a health forum about a herbalist man who prepare herbal medication to cure all kind of diseases including Cancer, at first i doubted if it is real but i decided to give it a try, when i contacted DR Anuge and he prepared a cancer herbal cure and sent it to me via Ups delivery company service, when i received this herbal medicine, he directed me on how to take the medicine, after taking it the way he instructed me to, i was totally cured of the deadly disease called cancer, all thanks to DR ANUGE, please you can get him contacted via email {Dranuge@gmail.com} or his WhatsApp on +2348164866838He can also cure following virus(1).HSV/1and2
    (2).Cancer
    (3).Hepatitis
    (4).Hiv/aids
    (5).Pcos
    (6).Fibroid
    (7).Hpv
    (8).Diabetes.

    ReplyDelete
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    Contact Us At : abdullahibrahimlender@gmail.com
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    Mr Abdullah Ibrahim

    ReplyDelete
  30. It’s obvious some patients with herpes are being enslaved to the antiviral and other supplementary Orthodox medicine just to help suppress the virus and not a cure. I have been with the virus since 2015 until I was introduced by a blogger who also narrated her story online on how she was cured of Genital Herpes after using Dr Odiagbe Herbal Medicine. This is a year and 2 weeks since I was delivered from genital Herpes. All thanks to God for using this Great herbalist to heal me. I have promised to keep telling good things about Dr Odiagbe. Please feel free to share Your problems with him and don’t forget to tell him I did refer you to Him. Thanks. Write him on mail Drodiagbeherbalhome82@gmail.com or WhatsApp +2349011108005  . He deals with Alzheimer virus, Cancer, HIV, Herpes, Genital, warts, ALS, BV, UTI, Virginal infection, Genital, Wart, HPV, Hepatitis A/B, Good luck, HSV, Pregnancy, Ex back. @dr odiagbe
    His Website: https://drodiagbeherbalhom.wixsite.com/drodiagbeherbalhom

    ReplyDelete
  31. I have a wonderful testimony to share to the whole world on how DR WONDER used his herbal product on me, I have been affected with HSV for 6 years and I might DR WONDER through a testimony shared by someone online and told my self let me give him a try and visiting many hospitals and herb home for cure and so lucky for me he did a wonderful job on me and the virus I have had for 6 years was completely cured, thank to DR WONDER for making me healthy again.
    If you also need his help you can contact him
    via email: Dr.Wonderspellhome@yahoo.com you can also call or whatsapp his +2349073364485 for any kind of help...

    ReplyDelete
  32. My health was horrible before I decided to try the Protocol Of taking Dr. Omola pure herbal mixture. I felt there was no hope for my health and I was to try the Protocol, thinking it wouldn’t work because I have visited so many hospital but same result. However, I was convinced by a Instagram friend to try the herbal medicine because I wanted to get rid of Herpes virus. The herbal mixture that was given to me was really quick and easy to take, within 2 week I was fully cured from Herpes. The herbal medicine really work and I will like to share this great doctor contact with you all email him dr.omolaherbalhome@gmail.com or WhatsApp +2348118116254 you won't regret it, I promise.

    ReplyDelete