We traveled to NYC on June 16th to meet with our surgeon, Dr. Bochner. We LIKED him very very much.
We were very impressed with his knowledge and his ability to also demonstrate incredible caring of his patients. Dr. Bochner allowed us to take our time, answering every one of our questions. He thoroughly explained Bladder Cancer, treatments and options.
One of the BIG questions for us was whether to have both chemo and surgery. He cleared so much for us. Here is what he explained. Hope this helps others.
First Step... he decides what is invasive and what is not.
If "muscle invasive", his recommendation is to do chemo first, then surgery. He states, that is the "Top Shelf" treatment to "muscle invasive" cancer.
He said, chemo can be given before or after, but post op chemo is not as well supported by studies that have been done only because of the smaller studies done. However, many think that the advantage of the chemo before, or after, is the same but studies haven't proven out yet.
The Reality---- there is statistically absolute improvement of about 7 percent in survival for those who have "combined" treatment over those who don't.
Overall relative benefit of combined treatment drops the risk of dying from bladder cancer by 14 percent over those who receive just surgery alone.
Downside he states of doing both RC and chemo....obviously some people whose tumour hasn't spread outside of the bladder and have no nodal involvement may not need the chemo. However, the problem is...they don't know who those folks are.
He said, their ability to stage the larger tumors isn't great. When they think the tumor is confined, about 1/3rd of the time pathologically it is thru the bladder wall.
Even if it is confined to the bladder ...20% of the time people will have microscopic involvement of the lymph nodes; involvement that is undetectable via CT scan, and is only detected via microscopic examination at time of surgery.
He continued that....even if those nodes are negative, ( for example: patient is stage 2, No, Mo... and has no chemo based on stage 2 No Mo) 20% of those people with organ confined disease with no lymph node involvement, will show up with the disease in other parts of their body. They cannot figure out who those people are prior to surgery because they cannot see microscopic disease.
That is why those who receive the chemo and surgery have a relative 14% higher survival rate than those who don't regardless of their nodal involvement at time of surgery.
That cleared the BIG Question up for us...
Cheryl
