Adjuvant Chemotherapy

Dear Rosemary and Wendy,

Many thanks for your messages.

Wendy I am not sure of the exact number of lymph nodes removed during the operation...only that two were affected with cancer cells. I will ask more detailed questions next time I have an appointment.

My Urologist mentioned they would maybe watch and wait for any micro metastisis to develop before offering a chemo plan.

At this point I am still waiting for my first appointment with an oncologist whom may advise on another course of action. This all depends on the outcome of my CT scan on the 29th of this month.

As far as I understand offering adjuvant chemo to hopefully search out and destroy any micro metastasis is practically impossible to check to see if the chemo is working during treatment as the micro metastasis are undetectable by scans and blood tests.

Is it also true that if I choose to go the adjuvant option and later develop metastasis the chemo options to me are limited because of resistance?

Do you know if they would offer the best chemo (gold standard) for an Ajuvant chemo option or would they save the best chemo for any future possible metastisis?

It seems to me also that adjuvant chemotherapy is not offered as standard in Holland unless entered onto a clinical trial. I may be wrong but this is my understanding...

Kind Regards
Leigh

Hi Leigh,

Do you know how many lymph nodes in total were removed, and how large the metastasis was such as <2mm or >2? Micro mets are treated differently in some other cancers. Maybe they feel the cancer is gone, or microscopic and that it would be more beneficial to wait for symptoms. This is how it's done with breast cancer, but breast is less aggressive than bladder cancer.

Are your uro and oncologist are consulting the AVL/NKI for advice on how best to proceed in your case? I was under the impression that is common procedure in The Netherlands. I would ask for a consult if this hasn't happened as they know what they're doing and could give the best information. Here's a Dutch site like this one:
diagnosekanker.nl/wws/info/lotgenoten-blaaskanker

You are right that most of the literature published suggests doing chemo sooner rather than later if lymph node mets are found in the path specimen post op. The are conflicting statistics about just how long survival may be extended, from 5-25% depending on things, but lower for those with lymph node involvement. However, I have seen people recover in this situation and get many years cancer free after chemo

Best of luck with everything and please let us know how it turns out,
Wendy
Amsterdam (breast cancer, patient at the NKI since surgery Dec.'99)

Leigh,

Hi. I am the Moderator for the Superficial Bladder Cancer Section. I am hoping that Wendy Sheridan will sign on soon and respond to your post. She is the Web Administrator for BLCWebcafe. She will be the best possible help for you as she is up to speed on all the latest treatment protocols and as she also lives in your neck of the woods.

Hang in there a bit. She'll be by.

Best regards,
Rosemary

Dear Forum,

My name is Leigh and I am a 38 year old male living in Holland. This summer I was diagnosed with invasive bladder cancer. On September 14th I had a radical cystectomy with a replacement neo-bladder. 10 days after my operation during my hospital saty my Urologist confirmed two lymph nodes were also affected.

I am waiting for an appointment with Oncology to discuss further treatment and a CT scan of my torso is planned at the end of this month to check for any metastasis.

My Urologist has indicated that I will not necessarily be having adjuvant chemotherapy. My Oncologist may decide to watch and wait for any micro-metastasis to develop before offering a treatment plan.

Having read articles on medical trials regarding adjuvant chemotherapy it seems to me that adjuvant chemotherapy has a more positive outcome.

I would be very appreciative for help on this issue from those with personal or professional experience.

Kind Regards
Leigh