Before removing the bladder, chemotherapy (or “chemo”) is often recommended (called “neoadjuvant chemotherapy”). The purpose of the treatment prior to surgery is to stop the disease from spreading through the blood or lymph system to other parts of the body and to reduce the tumours. In addition, chemotherapy is usually better tolerated prior to major surgery.

Not everyone is a candidate for pre-operative chemotherapy, however, and in such cases, it may be advisable to have post-surgery chemotherapy (called “adjuvant chemotherapy”). If lymph nodes are affected by the cancer, the oncologist may recommend adjuvant chemotherapy to combat further spread. The risk is that patients may decline post-surgery chemotherapy. This can happen for a number of reasons, including the fear of side effects, weakness and fatigue from the surgery itself, or thinking that the cancer is gone so chemotherapy is not necessary.

Chemotherapy has side effects which can be unpleasant and these must be taken into account by both you and your doctor. However, since the goal is to extend life with good quality, you should make an informed decision, based on the recommendation of your doctor.