It is important to realize, as pointed out above that there are many variables that play a role when it comes to surviving bladder cancer. In addition, bladder cancer treatment significantly improves survival. To emphasize, left alone, bladder cancer is deadly and would in many instances lead to death within 2 years. As an illustration, the following table is an attempt to summarize the information from Ref. 1 and 2 with regard to the 5-year survival rate. It measures the effectiveness of the bladder cancer treatment. However, some comments are necessary to explain the data. The table below shows that bladder surgery is superior to radiation therapy up to stage T3a, where radiation is as effective as surgery. However, at stage T3b 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.
5-year survival for bladder cancer with different treatments
|TNM stage||Surgery||Radiation||Radical surgery and chemotherapy||Chemotherapy, then radiation|
|Tis or T1||66 %||66 %|
|T2||59 %||46 %|
|T3a||34 %||35 %|
|T3b||16 %||23 %||54 %|
|T4||0 %||13 %||36 %|
In stage T4 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.
There seems to be a wide variation between different centres that reported these data. The reason likely is that from stage T3 onward there is so much variation in the cancer staging (grade differences, chromosomal variations, obscure 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.
Radiation, chemotherapy and combination with surgery
Similarly, with radiation alone only a certain proportion of cells gets eradicated, but the remaining cells are resistant to radiation and overcome the patient.
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.
Various treatments have different patient survivals
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 when radiotherapy follows chemotherapy. 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. With these cases “salvage” surgery followed initial chemotherapy to remove surviving bladder cancer. For stage T3b and T4 it seems that surgery is not that successful and radiation is more successful. But when a surgeon removed paraaortic lymph glands in a radical surgery in combination with chemotherapy or radiation therapy, the survival rates were better. 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.
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