Oncology (General Cancer)/Bladder cancer recurrence

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Question
My father-in-law, a former heavy smoker, was diagnosed with bladder cancer about eight months back, with bleeding as his primary symptom.  He responded well to intravesical therapy (scraping) and BCG treatment. There was no invasion of the muscle layer (muscularis propria). A recent checkup saw fresh spots of concern, which were also removed.  Again, no invasion of the muscle layer. I read that removal of the bladder is often recommended at this point, despite all the consequences. I've also read that "Repeat intravesical therapy may be appropriate in patients who develop a late recurrence after previous complete response to an intravesical agent."  Can you define "late recurrence?"  Thanks.

Answer
The use of interferon or interferon plus BCG can often salvage bcg failures and it would appear that your father in law might be a candidate for that.  Eight months would suggest a "late" recurrence.  Following failure with BCG and interferon, some urologists will go to Mitomicin C, a drug.  There are even other drugs after this.  If he were my patient, assuming I could remove the sites of recurrence by "scraping" or laser surgery, I'd want to try interferon and BCG, and assuming that failed, Mitomycin, before considering bladder excision.  Finally, there is increasing evidence that patients who are candidates for bladder removal might avoid removal if they have a complete response to intravenous chemotherapy; but of those who do, about half will eventually have to have their bladders removed.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

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.

Experience

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.

Organizations
American Society of Clinical Oncology

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

Education/Credentials
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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