Oncology (General Cancer)/Bladder Cancer Question


QUESTION: Dear Dr. Higby.  I was diagnosed with aggressive T2 high grade bladder cancer in November 2014.  Had a large tumor removed from the bladder.  My Urologist and Oncologist is saying that I need to have 3 months of intense Chemotherapy, MVAC followed by surgical removable of my bladder.  My recent blood work and PET scan showed that the cancer has not spread.  I asked my Oncologist about these tests and he said that they are normal, does this mean I no longer have cancer?  Is there a way that he can tell if I still do have cancer in my bladder?  Is it really necessary to have Chemotherapy and surgery?  Thank you.


ANSWER: It is highly likely that cancer remains in the bladder wall, and isn't detectable because the residual disease is minimal.  Your doctors are recommending the standard proven treatment for your cancer.  We know that MVAC followed by surgery is better than surgery alone to bring about cure.  There are some investigational studies in which chemotherapy and radiation are used without removing the bladder, and some of these patients are cured.  However, many eventually need to have the bladder removed because of recurrent cancer or sometimes, because the bladder becomes infected and scarred.  We know that people who have only what you had have an extremely high chance of the cancer coming back, although there are always a few people who seem to beat the odds.  
MVAC sounds scary, but if you have a good oncologist, you can probably handle it.  Ask about whether there are any clinical trials comparing MVAC to Gemcitibine/carboplatin, the latter of which is a newer and less toxic regimen.  And finally, discuss with your urologist whether he would create a "neobladder" after removing the bladder, so that you don't have to use a pouch.  
Finally, if you absolutely don't want your bladder removed even knowing that the risks of recurrence are higher, talk to the oncologist about the option of chemotherapy and radiation, followed by very close surveillance.  It's not standard, but cancer therapists know that it can result in cure.  
Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Higby, your answer has helped me a great deal and eased my mind about Chemotherapy as well as the regimen my Oncologist is recommending.  I do however have an appointment with another Oncologist for a second opinion.  One other issue that has arisen lately is that I saw the dentist the day before I was suppose to start Chemotherapy and he informed me that I have an infection in two of my teeth, he said that one of them needs to be extracted.  Would I need to have this done before Chemotherapy or during?  I heard that Chemotherapy will lower your immune system quite bit.  Thank you again.


I would definitely have the extraction done before chemotherapy, for the reasons you mention, and also because with MVAC you might have lowered platelet counts for a while, which makes an extraction a little more risky than normal.  Hope this helps.  I also applaud your getting a second opinion.  I do not disagree with your doctors but at least you'll have confirmation -- or another way to go.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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