IM- Chemotherapy
harry206 - 06-06-09 03:38

A 62-year-old man with a long history of cigarette smoking comes to the office with a 3-month history of painless gross hematuria. Physical examination is unremarkable. Urologic evaluation, including cystoscopy, reveals a medium-sized bladder tumor. You recommend a surgeon to the patient and a transurethral resection is performed. The pathology shows high-grade transitional cell carcinoma invading the muscularis propria. A metastatic workup is negative and the patient is counseled regarding radical cystectomy and urinary diversion. A radical cystectomy, pelvic lymph node dissection, and ileal conduit are performed successfully. The surgical margins and lymph nodes are all negative. An 18-month follow-up CT scan of the pelvis reveals a 4-cm heterogeneous, contrast enhancing mass. A biopsy shows a high-grade transitional cell carcinoma. The patient is referred to an oncologist who suggests chemotherapy using a platinum-based regimen. He comes back to your office and tells you that he has heard so many "horror stories" about chemotherapy and that he is concerned about the toxic side effects of the recommended platinum-based regimen. He should be told that this regimen significantly increases his risk of developing