Chemo recommendation s/p bladder removal w/ neobladder

[doodle94]

My mother was diagnosed w/ bladder CA. The initial stageing was stage II high grade transitional cell.  She just had a cystectomy and reconstructive surgery of a neobladder.  She initally had a CT done which was normal and the tumor was found via a cystoscopy.  The tumor was invasive into the muscle of the bladder even though upon inital inspection showed that when the tumor was removed the tissue/muscle looked pink and clean. All the bx'ed sites w/in the bladder came back malignant and she was then dx'ed w/ the stage II. During the surgery the surgeon took a frozen section of the lymph and it was clean. They also said that it looked to be contained w/in the bladder only that while it had invaded into the muscle it didn't actually penetrate the bladder wall. The pathology results won't be available until next week. My question is:  if it was just contained w/in the bladder and didn't actually penetrate the wall itself or the lymph would she benefit from a few cycles of chemo or would this be over kill?  Also, if the path report comes back poor what additional tests would you recommend? They said that they looked all through her abdomen during the 10hr surgery and said that everything looked clean. What is your opinion on her prognosis pertaining to both situations. Also, what if any, complications from the surgery or neobladder is to be expected? She has had bowel obstructions in the past and takes Reglan 3x/day.  Even w/ this she will still need to use a fleets enema on occasion to have a BM. This is an obvious concern and her DR. started her back on Reglan IV until PO is permitted. She also has an epidural instead of a PCA for pain control to assist in preventing additional problem secondary to narcotic use. Her pain is currently controlled although she does present w/ some sharp pains in the abdomen frequently (post op day 1), which I am hoping is flatus which I'm assuming is a good thing for the bowels.  Any information you could provide or suggestions you may have would be greatly appreciated and helpful.  Thank you very much for your time.

[Kevin Pho, MD]

There are no clear guidelines.  The options should be discussed with your oncologist.  

Regarding stage 2 bladder cancer, some say treatment with concurrent chemotherapy and radiation therapy has been associated with improved rates of local control compared with historical series of patients treated with radiation therapy alone. The only prospective, randomized comparison of radiation therapy and chemoradiotherapy reported an improved rate of local control when cisplatin was given in conjunction with radiation therapy.

Multiple clinical trials are evaluating the potential of chemotherapy administered prior to cystectomy, following cystectomy, or in conjunction with external-beam radiation therapy to improve local tumor control, prevent distant metastases, or allow preservation of the bladder.

It has also been suggested that if there is evidence of extravesicular disease or node-positive disease following cystectomy, then chemotherapy can also be considered in these cases.

These options should be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Bajorin.  Adjuvant and neoadjuvant chemotherapy for bladder cancer.  UptoDate, 2004.

[kevinmd]

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