When we refer to someone as being “cured” of a dis-ease, we generally mean that the disease is gone forever and will not recur. When we refer to a person’s cancer as cured, we generally refer to a period that must elapse with no evidence of recurrence. For many patients, there is indeed a cure for bladder cancer. Those patients with low-grade, superficial cancer will in a sense be cured when they undergo removal of their entire tumor. Unfortunately, bladder cancer tends to recur in other areas of the bladder. Even though the entire tumor was removed, new tumors can grow in either the same or different locations.
Thus, despite having had your entire tumor removed, you will still need to be monitored regularly. Many recurrent tumors, when detected early, are still curable tumors. For those patients with tumors that have invaded the bladder muscle, cure is still possible. Either part or all of the bladder can be removed. If the surgeon is able to remove the entire tumor, then you are said to be cured of the cancer. Surgery will cure approximately 80% of the tumors that are confined to a person’s bladder. Unfortunately, again, it is impossible to know for certain that the entire tumor has been removed. Microscopic amounts of tumor may have escaped the bladder, and the surgeon has no way of detecting when this happens.
In cases in which this is suspected, such as the presence of tumor cells at the edge of the removed tissue, chemotherapy or radiation may be added to improve the chances of curing the microscopic tumor that remains in the body. Patients with locally advanced cancer have only about a 20% to 30% chance of cure with surgery alone. Surveillance by a urologist after surgery is always important to ensure that the tumor does not recur. Finally, those patients who develop metastatic cancer can still be cured.
Combination therapy with surgery, chemotherapy, and/or radiation is now able to cure a small but growing number of these patients. Most patients will at least respond initially to chemotherapy. As with the other examples, it is difficult to say at what point we can call a patient cured. Surveillance with X-rays, computerized tomography (CT) scans, cystoscopy, and cytology remains important for years after therapy.