Stage 3 Bladder cancer

17 years 11 months ago #433 by Mike
Replied by Mike on topic Stage 3 Bladder cancer
Hi Linda,
I hope all is well with you. Al saw Dr. Kibel yesterday and the news was devastating.... His bladder cancer has metastized to one kidney, liver, and lymph nodes. Dr. Kibel has decided not to perform the bladder surgery since the cancer has spread and he is not having any problems with urination at this time. I got him an appointment with Dr. Picus at the Siteman Cancer Center for Tuesday 4/11. Dr. Kibel advised Al to fight this with all his has. Al is very strong and is ready to start chemo. There seem to be good moments that he feels strong and then moments that he is very scared and hopeless. I can't even begin to understand what he is going through however I am feeling the same way. I will do whatever I can and we will just have to take one day at a time. Take care. Marci

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17 years 11 months ago #418 by LindaW
Replied by LindaW on topic Stage 3 Bladder cancer
Hi, Marci,
Thanks for the prompt update, The news of possible spread is troubling. However, Dr. Kibel has impressive credentials, and I am sure he will help Al find the right treatment path that is appropriate for his diagnosis. I am pleased that he is being treated at a well respected cancer center by an experienced, qualified urosurgeon. If you or Al have any questions, just ask. Please continue to send us updates. Al is lucky to have you as a friend.
My best to you and Al,
LindaW

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17 years 11 months ago #417 by Mike
Replied by Mike on topic Stage 3 Bladder cancer
Thank you so much for taking time to respond. I can not tell you how good your timing was. He has had a second opinion with Dr. Kibel at Washington University (we live in St. Louis, MO). He seemed very optimistic regarding possible treatments. He believes Al would be able to withstand bladder removal. He ordered blood tests, a chest x-ray, CAT scan and bone scan to see if the cancer has spread. The CAT scan and bone scan were done yesterday. When we got home from the hospital there was a message to go to the ER to been evaluated for an inflammation around the bladder. Apparently the scan showed a large number of stones in the gallbladder but since there were no symptoms the surgeon decided not to remove it at this time. The ER doctor was very concerned re: the scans and asked the urologist to come to the ER to give us the results. Dr. Kibel is out of town so another doctor in his office gave us vague details however did say the cancer has spread. He wants us to wait until next Thursday when we see Dr. Kibel to discuss treatments however he did verify that there was a tumor blocking one kidney and suggested there may be some bone involvement. Of course the news was devastating however at this point we are not exactly sure how bad this situation is. Al is in very good spirits and is ready to fight with all he has. He is feeling great. I will keep you posted when there is an update. Again thank you so much! Best of luck to you. Marci Healy

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17 years 11 months ago #413 by LindaW
Replied by LindaW on topic Stage 3 Bladder cancer
Hi, Marci,
Your friend needs to get a second opinion from a cancer center of excellence...most of these are connected to major academic centers. Where do you live? Although there are some urosurgeons who let age disqualify someone from radical cystectomy(RC) surgery, there are plenty that go by the health of the individual not the age. My urosurgeon performed a radical cystectomy with a neobladder urinary diversion in a woman that was 85 years old at the time, and last I heard she was doing beautifully with a neobladder that was functioning as intended. Neobladders are the type of diversion that is an internal pouch that connects to the urethra so voiding does not require catherization. Many surgeons are hesitant to give neobladders to women and/or the elderly, yet, here is this 85 year old patient of my urosurgeon that is doing great with her neobladder and with a good prognosis for the future .

The lymph/vascular invasion is a worry, but to me it means that he should have an extended lymph node dissection so that as many local and regional lymph nodes as possible are removed just in case cells have escaped the bladder through the lymph/vascular system. USC Norris urosurgeons remove as many as 65+ lymph nodes whereas most centers remove between 10-20. My surgeon removed 7 from each side for a total of 14 and I wish he had removed many more just to be on the safe side. USC Norris has the best long-term survival rate compared with other major centers, and I cannot help but think their stand on extensive lymph node removal influences those good results.

Here is an excerpt from a  medical journal artical about RC/urinary diversions in the elderly with 52 of the patients in this study 80 years old or older:
"CONCLUSIONS: These data suggest that an aggressive, curative, radical surgical approach and urinary diversion may be a viable treatment strategy for properly selected elderly patients who are in generally good health and require definitive therapy for invasive bladder carcinoma."
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9655304&dopt=Abstract
or
tinyurl.com/nu6pw

Here is another:
"In conclusion, indication of cystectomy and selection of urinary reconstruction procedure are not dependent on patient's age, Orthotopic urinary reservoir [neobladder] was found to be useful for even an elderly patient.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10086261&dopt=Abstract
or
tinyurl.com/pbkfd

And, another:
"Conclusions: Radical cystectomy can be performed in elderly patients with acceptable perioperative mortality and morbidity. However, because of the high incidence of minor medical complications, hospital stay is often prolonged."
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224083&Ausgabe=227844&ArtikelNr=52498&filename=52498.pdf
or
tinyurl.com/m3xrw

I could probably find more references if you need them.

By the time you read this, your friend would have had his second opinion. I am sorry I did not read your post earlier so I could have responded earlier. Again, I cannot stress enough just how important it is for him to be seen at an academic cancer center that does many of these type operations. These are the urosurgeons with the knowledge and experience offer your friend with the best treatment path for his survival. Please let me know what the second urologist advised. where you live, and who he saw.
Hope this helps,
Linda W. neobladder 2/2002



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18 years 5 days ago #376 by Mike
Stage 3 Bladder cancer was created by Mike
My landlord, who I have become very close to, was just diagnosed with bladder cancer. The diagnosis was stage 3 cancer with detrusor muscle invasion and lymph/vascular invasion. I am not familiar with this subject however I am researching this for him. He is 85 years old however is in relatively good health. We went to see his urologist today and the news was not good. The doctor said considering his age he wasn't sure that surgery was an option so he suggested doing nothing. He offered very little information. I was lucky enough to get him in with another doctor was a second opinion tomorrow. He is of course devastated and wants to try anything. Is the surgery to remove the bladder too invasive? Any information would be greatly appreciated. Marci Healy

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