Here is my understanding but please understand I am not a doctor.
Chemo before is typical if there is something to be seen. Chemo after depends on how deep into the muscle the tumor is when they remove the bladder and do all the pathology on it.
I did not get chemo. The chemo is to kill any potential micro mets (metastasis that cannot been seen on any scans/tests). If there is any lymph node involvement, then chemo is for sure.
In my case, there was no lymph node involvement and he took out something like 41 (I'm pretty sure that was the number) lymph nodes. I was just tested a few months ago and I'm still cancer free and the probability is very high that there was no mets and there won't be after this amount of time.
If they suggest chemo prior to surgery, I guess I (if I were you) would want to hear all of their reasoning behind that and make the decision myself.
My T2 was just barely into muscle. If it was getting close to being T3, it may have been a different story because the chance of micro mets would be much higher.
Your doc is going to have lots more info on this than I am so my suggestion is, armed with the info I just gave you, have that discussion with your doctor (in detail) when you talk to him about the path forward for you.
Hope that helps!
Mike
Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...