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Odds of death in 5 years for bladder cancer:
Stage 1 (non-muscle invasive): 20%
Stage 2 (muscle invasive): 45%
If one has stage 1 cancer, would replacement of the bladder drop mortality below 20? Would it prevent stage 2 (prevent 45% mortality)? Maybe a neobladder should be considered for all stage 1 patients? Maybe a neobladder should be used if stage 1 cancer repeatedly grows back? Maybe a neobladder should be used if stage 1 cancer is high grade (high grade means most likely to spread to other parts of the body and most likely to grow rapidly)? Maybe tiny cancer cells have spread to the prostate, testicles, or (backward) to the kidneys, so neobladders might be too late to change the statistics much?
ABOUT THE NEOBLADDER:
A neobladder replaces all (or part) of a bladder with a section of large or small intestine. Most digestion occurs in the large intestine. Shortening the large intestine might cause frequent shitting. So, perhaps it is better to use small intestine? Sometimes it is possible to save the nerves that control urges to pee, by replacing only part of the bladder.
An alternative to a neobladder is proton beam treatment for stage 2 cancer.
MY POINT:
Doctors want to do anything that they can to save patients’ own bladders so they can pee normally (without a timer or sensor to tell them when their bladders are full). But is it worth risking death to keep one’s bladder?
A CLOSER LOOK AT THE STATISTICS:
If one has stage 1, mortality is 20%. This means that 80% will live for at least 5 years. For those who change from stage 1 to stage 2, the number of people who live will drop to 55% (that is 100% – 45% mortality). So, instead of 80% living, only 55% will live. It is a drop of 55/80 = 68.75%. That means that of the 80% who would live (if they had stage 1), 100%-68.75% = 31.25% would die if they got stage 2 cancer.
In other words, (if you ignore the number of people who would die with stage 1 anyway) roughly 1/3 of all of the patients who would have lived with stage 1 would die if it developed into stage 2 cancer.
Isn’t cancer like playing Russian Roulette? Making the wrong decision about cancer is like making the wrong decision to pull a trigger with a gun against your head. If you loaded a six shooter with 2 bullets, would you play Russian Roulette? (Remember, the odds are that 1/3 healthy people would die playing Russian Roulette, and the odds are that 1/3 of the people who would survive Stage 1 bladder cancer would die if their cancer changed to Stage 2).
It seems to me that a neobladder should be used to prevent 1/3 of the healthy people from dying. There is no point in playing Russian Roulette with 2 bullets in a six shooter, if one can avoid Russian Roulette with a neobladder.
You’ve raised some good points. However what I have found with members of my support group (several diagnosed with Stage 1) is that they have different feelings and opinions on how it should be treated. Doctors do vary on their protocol for treating this stage, at least in Calgary. Some in my group were recommended to go for an RC, others to try BCG first. Some were willing to give BCG a go, others said screw it, they weren’t willing to chance it with BCG and went for the RC surgery.
So I think what I’m trying to say is that patients vary in their mindset when it comes to treating this disease; some will fight tooth and nail to keep their bladder; others see an RC as a more definitive chance at a complete “cure”. That is something that must be taken into an account as well as the doctor’s recommendations.
Good points.
It is a risk vs benefits vs quality of life, combined with age, general health, age, pathology reports etc, at time of diagnosis, to make an informed decision regarding which treatment is bast, at which time, for each individual. Complex algorithms.Up to 3 feet of the small intestine is used to create a neobladder, at least in Canada only the small intestine is used.
For a man, keeping his bladder also preserves his prostate gland, which preserves his ability to have and maintain erections, with the prostate removal, at time of neobladder construction, this ability is lost for many men. A quality of life determinant. Psychological impact.
For a woman, the uterus and ovaries are removed, creating instant menopause, which can also affects quality of life issues.The internal sphincter is also removed at time of surgery…this is the strongest “gatekeeper” for urine control. Many are not able to strengthen the secondary sphincter adequately so that incontinence becomes a lifestyle to deal with.
Having an RC is not necessarily a cure…many a post op pathology report show that the bladder cancer has invaded lymph nodes, requiring further treatment post op with chemotherapy and/or radiation. For more than 25 years there have not been advances in bladder cancer treatment – UNTIL just recently…which is great news for those who will develop bladder cancer now and in the future.
Not sure where you got these statistics, but where is Stage 0. Most diagnosed with bladder cancer have stage 0 either low grade or high grade, and there is also CIS which is high grade but can be Stage 0 also. Stage 0 depending on grade of tumor can sometimes require no treatments, some just 1 injection of Mitomycin C and some BCG. In most cases bladder removal is not even considered, due to the different treatments available.
Jack
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