Newly diagnosed - confused, help - chemo ok? at 83

4 months 3 weeks ago #60615 by fabulous
Diagnosed with muscle invasive bladder cancer, 2 months ago, age 83 but in good shape, active, no other serious medical condition, currently unable to decide. 

1. Decided on the surgery but not able to decide on which is better - treatment with chemo MVAC before surgery or go to surgery directly. 

2. How do I find out the number of surgeries a surgeon has done - not listed anywhere I searched.  Would that be a fair question to ask after the first visit because I didn't ask. 

3. Have talked to 2 centers - one offered surgery now and possible chemo after if needed, vs the second one offered MVAC now 2 months later surgery.  My preference was MVAC with the first surgeon - who has tremendous experience.  The second surgeon - not sure  how much experience he has but the facilities are both high performing cancer centers.
4. Any one with experience with MVAC after the bladder removal, and what is the success rate for that?
5. 83 but in great shape, but the first facility does not want to give me the MVAC because of age, any advice on how I can retain the doctor and convince the medical team I would like chemo?  I like both surgeons in the first meeting, but I also know personality is not the important thing here. 

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4 months 3 weeks ago #60616 by Jack R
Fabulous,

A few short comments I hope are helpful.

Every question you have is a fair question to ask a potential doctor. Your doctor needs to respond to your concerns so that you can make an INFORMED decision about your treatment. My questions include the doctor's experience, who I can call 24/7 if there is a problem, and if a particular treatment is recommended I want to know ALL about the other options, and what to expect after and during recovery. My body and questions are important, so are yours. Yes, I have declined to be treated by well respected doctors who "would not make time to answer questions."

As I understand it, squamous cell cancer (SCC), being far less common than Transitional Cell Carcinoma (TCC), has less research to support chemotherapy prior to bladder removal. Again, it is a fair question to ask WHY one doctor approves prior chemo while another does not. Many doctors have 'favorite' procedures or practices.

Number of bladder removals a doctor performs is a fair question. The minimum number has often been discussed or debated in this forum. Important but not mentioned, is the urinary diversion you would prefer, if possible. Search this forum for RC or Radical Cystectomy and Diversion.

A google search for reliable sites, looking for Squamous Bladder Cancer Treatments will offer some information on the subject.

To get what you want, asking directly produces the best answers. But first, do ask why chemo is not offered, or why it is not offered "at your age".

Feel free to ask ANY questions in this forum. No doctors here, just others with bladder cancers who have a range of experiences.

We do disagree on doctor personality. I want doctors who support (rational) patient involvement.

Best
Jack

6/2015 HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
Tis CIS comes back.
BC clear as of 5/17 !
RCC found in my one & only kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021
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4 months 3 weeks ago - 4 months 3 weeks ago #60620 by fabulous
Thank for your advice.
Does getting MRI and status of lymph nodes make a difference in whether going to surgery now vs wait to after surgery? How long do people wait after chemo before bladder removal surgery? We are leaning to the diversion with the urinary bag?

Does anyone know if there is a big difference in side effects between GC or dd MVAC chemos?
Does anyone in the 80 have done well with these chemos?

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4 months 2 weeks ago #60621 by Jack R
Fabulous,

This forum has a SEARCH box at the very top. Entering a word or two will likely take you to earlier comments and replies on the searched topic. Others, over a few days may direct comments to your questions.

None of us are doctors, so much will be based on personal experiences, and results will vary.

Doctors can't and don't 'guarantee' outcomes. They can explain the goals, risks, and some likelihood of a successful treatment. They are also the best source of eliminating potential treatment choices that appear unfavorable to a particular patient.

Read here, using search and browse to understand the range of opinions people have dealt with, then ask the doctors to personalize an answer as well as thy can. You are on the right track to making your decisions.

Best
Jack

6/2015 HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
Tis CIS comes back.
BC clear as of 5/17 !
RCC found in my one & only kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021

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