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Bladder Cancer Stage II- Chemo? Cystectomy?

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Hi David- I have been diagnosed with bladder cancer stage II. The mass was removed but the cancer may have invaded the muscle tissue. My oncologist wants to go with NCCN  guidelines and recommends the chemo 8 rounds and full bladder and prostate removal. What are some of my options? 🤔

Hi Bryan-
I am sorry to learn of your bladder cancer diagnosis. You have several issues to consider. Regardless of which direction you go in, I recommend finding an oncologist who specializes in bladder cancer.
Undergoing both radical cystectomy and chemo as a treatment plan for stage 2 bladder cancer is aggressive treatment. Understand that I am biased against aggressive treatment due to the risk of side effects.
It is not clear from your questions if your bladder cancer is local, regional or systemic aka through your body. This distinction is central to your choice of therapies and the potential success of those therapies.
My thinking is that you have two choices. 
1) if you are stage 2 and the original tumor has been removed as you say in your original post, you can undergo chemo and radiation. Consider evidence-based but non-conventional therapies shown to manage the side effects of chemo and radiation. 
2) radical cystectomy- have your bladder removed. I will link a post of a survivor of this procedure. Tom wrote the post and is very positive about the therapy. 
Much of the decision will depend on your goals. Meaning, some people want to undergo more aggressive options because the are younger, want to be more aggressive, etc. Some people think more about quality of life and therefore don’t want to risk side effects.
If you would like to learn more about a cystectomy, I can put you in touch with tom johnson, the bladder cancer survivor who wrote the post below. Nice guy, knowledgeable.
Let me know if you have any questions.
David Emerson
  • Cancer Survivor
  • Cancer Coach
  • Directior PeopleBeatingCancer

Bladder Cancer: Types of Treatment

ON THIS PAGE: You will learn the basics about the different types of treatments doctors use for people with bladder cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for cancer. “Standard of care” means the best treatments known so far. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new or modified approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options, including clinical trials…”

Bladder Cancer- A life Changing Success

“In late November 2014 I had lost 35 pounds after retiring earlier that year. I had been taking a blood pressure pill with a diuretic and because of the weight loss I thought the diuretic was too strong making me go to the bathroom all morning after three cups of coffee. I saw my doctor that week and took a urine test to see if anything else may be contributing to the problem.

The test showed minute traces of blood even though visibly my urine was clear. I was referred to my urologist and saw Dr. Eric Klein of the Cleveland Clinic the next week. Dr. Klein is the Chairman of Urology at the Clinic Glickman Tower main campus.

Dr. Klein did a scope of my prostrate and my bladder and found multiple tumors in my bladder.  That was on 12/19/2015.  I was surprised because I am a non- smoker and do not drink alcohol.

Dr Klein scheduled a TURBT procedure on 12/23/15 at the Beachwood Clinic to remove the tumors and check pathology. The procedure took an hour and was Outpatient. Dr. Klein’s initial prognosis after seeing the tumors is that they were cancer and there was a strong probability I would have to have my bladder removed…”

Radical cystectomy: a review of techniques, developments and controversies


RC plays a central role in the multimodal therapy of patients with high risk NMIBC and MIBC. The negative impact on quality of life and the high rate of peri-operative complications pose important limitations, especially in the context of a disease that affects primarily elderly patients with multiple medical co-morbidities.

RC must therefore be viewed as one element of a complex, multidisciplinary treatment plan.

Measures to improve outcomes include:

  • regionalization of care to high volume centers,
  • the use of ERAS protocols,
  • and technologic advances such as robotic surgery,

although this last element has yet to have a major impact on outcomes. Patient selection and the tailoring of the urinary diversion to the patient’s needs are paramount. Level I evidence to direct the use of the extended PLND is eagerly awaited in the near future, and neoadjuvant therapies are likely to evolve with advances in systemic therapy. These are all meaningful strides in the effort to improve patient outcomes…”



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