Viable Alternative

Chemotherapy before surgery saves diseased bladder.

After toiling for more than 50 years as a landscaper and supervisor with the Pasco County Parks and Recreation Department, Timothy Jacoby retired this past summer while working the most important job he’s ever had – fighting cancer.

Timothy Jacoby saved his bladder by choosing a non-traditional path toward treating his bladder cancer.

Joann & Timothy Jacoby

“Bladder cancer, to be specific,” Timothy, 66, confirms. “It was discovered at the beginning of July after my primary care physician thought the cause of some bleeding I was experiencing while urinating might have been a urinary tract infection.

“That’s what I was being treated for when, just a few days after those treatments started, I was at work one Saturday when the bleeding became very heavy. I didn’t know what was happening, so I went to the emergency room.”

A series of tests performed during Timothy’s visit to the emergency room revealed a large tumor near the upper right side of his bladder. It was not only causing the bleeding but was partially blocking Timothy’s kidney and ureter, which is the duct by which urine passes from the kidney to the bladder.

A cystoscopy, or examination of the bladder, was scheduled for the next day, but the urologist who performed that procedure could not remove all of the tumor, which proved to be cancerous and had spread to the muscle around the bladder.

It was in the wake of that discovery that Timothy and his family were introduced to Jorge Ayub, MD, a board-certified hematologist and medical oncologist with Florida Cancer Specialists & Research Institute who broke the news and explained Timothy’s options.

The Other Option

One of those options was to remove the bladder, which for years has been the solution most doctors have followed when treating patients with bladder cancer. The other was to first try to destroy the tumor with chemotherapy, which is a relatively new approach.

“New studies have looked at the effects of the administration of a few cycles of chemotherapy up front – before any local surgery is done – and these studies show that this approach can improve survival rates,” Dr. Ayub educates.

“The administration of the chemotherapy decreases the chances of the cancer spreading outside of the bladder, which is important, because most patients in this situation do not die because of the local issue.

“They die because of the cancer’s ability to travel outside the inner layer of the bladder, which is where the tumor starts. Oftentimes, the tumor stays in that first layer. But once it invades the muscle, that’s when the risk of it spreading further increases.”

Timothy spent a few days in the hospital recovering from the cystoscopy. To allow for proper urine flow, a catheter was inserted into the ureter. During that time, he discussed his options with his family and decided to try the chemotherapy.

Those treatments began immediately, and over the course of the next 12 weeks, Timothy received four cycles of chemotherapy that called for an initial chemotherapy treatment on day one of the cycle and booster treatments on days eight and 15.

In addition to receiving the chemotherapy, two forms of which were administered intravenously, Timothy was given medications to reduce the drug’s side effects. He says those medications worked well, as he suffered only from fatigue during the treatment period.

“He didn’t lose his hair or get sick or anything really,” Timothy’s wife, Joann, confirms. “He did really well, so he was always happy and willing to go in for his treatments, and that helped keep his spirits up through the whole process.”

All Gone

Timothy’s spirits soared even more when a follow-up cystoscopy done in the wake of the chemotherapy treatments revealed that the chemotherapy had completely destroyed the tumor as well as the cancer that had spread to the muscles around the bladder.

“The doctor went in to remove what was left of the tumor, and all of a sudden, he says, I don’t see anything,” Timothy remembers. “So he called the nurse over, and he asks her, Do you see anything? And she said, No, I don’t see a thing. It was all clear.”

“The doctor told us that it would probably take about forty-five minutes to go in there and scrape out the rest of the tumor, so we got a little nervous when he came out after just fifteen minutes and said the surgery was done,” Joann adds.

“But then he told us that there was no tumor left to remove. The whole thing was completely gone. You know, there’s a saying that says God gives you good doctors, and I knew then that the Lord gave us a good one in Dr. Ayub.”

Dr. Ayub described the outcome as “very rewarding,” and noted that by ridding Timothy of the cancer, the chemotherapy treatments also allowed the ureter to open up, which eventually allowed for the catheter to be removed.

He warns, however, that Timothy’s battle is not yet over.

“Even in situations where we get a complete pathological remission, the question still remains: Are there any residual cancer cells left?”  Dr. Ayub explains. “That’s because you’re only sampling where you saw the abnormality.

“That’s why Timothy will still need to undergo some radiation therapy to ensure he saves his bladder. But the key point is that patients should consider chemotherapy treatment before undergoing a bladder resection if there is tumor-invaded muscle.

“If the tumor is only in the first layer, it’s basically a urological treatment. But if it’s not and the patient is in relatively good shape, you don’t necessarily have to remove the bladder to rid yourself of the cancer. That’s not the only option.”

Timothy says the fact that he was given that option is why he has developed so much trust in Dr. Ayub and why he and Joann have so much respect and admiration for the entire team of health care professionals at Florida Cancer Specialists & Research Institute.

“Dr. Ayub is a wonderful doctor, and the staff at Florida Cancer Specialists and Research Institute is fantastic,” Timothy exudes. “You really couldn’t ask for a better team of people or for better service than you get there. I know that for a fact.”

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