Chemo before or after an RC

[KIOWA]

I’m not asking this for myself, thankfully, but from time to time I like to present things like this for new members or for those who just read our posts. A lot changes in medicine, treatments and interventions and I want to get some feedback from our members and soon to be members as to what their thinking is or what they understand the latest thinking is in the area of bladder cancer. My own thinking is that it depends on the stage of the BC as to whether or not chemo should be done (if at all) prior to or after and RC. Thanks for the input.

Kiowa

[marysue]

This was a topic of discussion at our last support group meeting and it seems that in Calgary the uros mostly opt for chemo before an RC and only for cancer greater than T2 or a more rare type of cancer. A couple of members said that they started chemo but had to quit as the drug was compromising their kidney function. One gent found himself in this situation and he actually was only expected to survive for about a year. He is more than 3 years out from his RC and doing well other than coping with some infection in the stoma.

This is a personal opinion only, but I feel we have to be very careful when using these heavy duty drugs and less is more in some cases. People need to seek the advice of their docs and get a second opinion if necessary to make sure that this is the route that will give them the best possible outcome.

[Greg]

Kiowa:
I was unable to have neo-adjuvant chemo due to the unfortunate delay in diagnosis of invasive disease and the decision to do an RC necessitating immediate surgery two weeks later. To do with second opinions and the first uro deciding there was no rush to RC (a decision I was ignorantly content with since I had a deep desire to avoid the RC). In other words, I was uninformed and happy until you folks on this site told me to get informed and be unhappy – and get a second opinion which cost me my bladder. But saved my life! I’d have been blissfully ignorant right up until my demise. I’ve learned a lot about becoming one’s own best advocate.

Adjuvant chemo was all set up until my surgeon reviewed the pathology report with me a few weeks after surgery and told me I did not need it since the cancer was contained. The med onc was not too pleased but admitted that there was a paucity of study on whether adjuvant chemo would be of any use in my circumstances. With the possible side effects of damaging kidneys and neuropathy from the chemo, I chose to decline it (as a type one diabetic I already watch my kidney function and nerve disease in my peripherals quite closely since those issues are known complications of long term diabetes).

Is there distant metastatic disease? Will the cancer recur? Should I have done the chemo anyway? Time will tell the tale. No regrets.

[G and M]

For people new to this disease, you rely heavily on your doctor’s advice. My doctor said I was a candidate for neoadjuvant therapy and recommended it based on the following:

1. Chemotherapy may be better tolerated before RC (major operation)
2. Tumor down staging from chemotherapy can occur
3. Neoadjuvant chemotherapy has been shown to marginally improve survival short and long term (speak with your doctor about trial results)

He left the decision up to me and told me to do some research on the topic. After a few weeks of research, speaking with family members and the advice from my doctors I choose to undergo chemo before my surgery.

Note that chemotherapy can have many side effects and cause complications, some very serious. So the benefits and downsides should be evaluated carefully. Consultation with a specialist is highly recommended. I suggest anyone considering undergoing chemotherapy ask to speak with a chemotherapy doctor at the cancer hospital before hand.

The future will tell if I made the right decision, but I am comfortable with the decision I made.

Glenn

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