Bladder Cancer Treatment

As pointed out above there are many variables that play a role when it comes to surviving bladder cancer. Left alone, bladder cancer is deadly and would in many instances lead to death within 2 years. The following table is an attempt to summarize the information from Ref. 1 and 2 with regard to the 5 year survival rate, which is used as a tool to assess the effectiveness of the bladder cancer treatment. However, some comments are necessary to explain the data. The table shows that bladder surgery is superior to radiation therapy up to stage  T3a, where radiation is as effective as surgery. However, at stageT3b the best results come from initial chemotherapy followed by subsequent radiation, while with radiation alone the survival would be 31% less than the combination treatment.

In stageT4 the best results are obtained from initial radical bladder surgery followed by combination chemotherapy (which includes cisplatin). The best outcomes are highlighted in the table above by shading.

The reason there seems to be a wide variation between different centres, which reported these data, is that from stage T3 onward there is so much variation entering into the cancer staging (grade differences, chromosomal variations, hidden metastases) that the predictions for outcome are not that reliable. The reason that surgery does poorly at the T3b and T4 stages is that paraaortic and pelvic lymph nodes are left behind, which would subsequently kill the patient. This has to be addressed with chemotherapy, radiotherapy or both.

Even with the combination of surgery, which takes care of the local tumor, and with chemotherapy, which takes care of the metastases, there is a lot of room for improvements. The introduction of cisplatin many years back into the chemotherapy program has vastly improved survival of patients.

It appears that a more local cancer, low grade cancer and a cancer with less chromosomal abnormalities has the better 5-year survival rate. The same is true for chemotherapy followed by radiotherapy. For stage 4 Ref. 7 reported a 41% 5-year survival rate with chemotherapy alone and a 33% 5-year survival rate for more difficult cases where initial chemotherapy had to be followed by "salvage" surgery to remove surviving bladder cancer. For stage T3b and T4 it seems that surgery is not that successful and radiation is more successful, except perhaps when radical surgery where paraaortic lymph glands are removed, is combined with chemotherapy or radiation therapy. The Cancer Clinic will advise the patient as to what treatment approach will likely give the best long-term survival rate.

Here is a link for more info on bladder cancer treatment.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997.

2. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et al. J.B. LippincottCo.,Philadelphia,1993.Chapter 34, page 1054 (data from text arranged as a table).    

3. M Simoneau et al. Oncogene 2000 Dec 19(54): 6317-6323.

4. G Dalbagni , HW Herr  Urol Clin North Am 2000 Feb 27(1): 137-146.

5. HW Herr J Clin Oncol 2001 Jan 1;19(1): 89-93.

6. DA Corral, CJ Logothetis World J Urol 1997; 15(2): 139 - 143.

7. PM Dodd et al. J Clin Oncol 1999 Aug;17 (8): 2546- 2552.

8. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

9. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

10. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc

11. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: March 29, 2012