What causes fatigue and leg swelling post-cystectomy?

Question

Hi doctor,

My uncle, who is 62 years old, was diagnosed with muscle-invasive urothelial carcinoma and recently underwent a radical cystectomy. The pathology report showed some lymph node involvement, and his oncologist is now suggesting adjuvant chemotherapy. We are unsure about how aggressive this treatment should be, considering his post-surgical weakness.

His recent laboratory reports indicate stable kidney function, but he has been experiencing persistent fatigue and mild swelling in his legs. Could this be a side effect of surgery, or should we be concerned about cancer spreading? Also, are there any advanced imaging, like PET (positron emission tomography) scans, that should be done now to assess residual disease? We are also worried about his long-term quality of life. Adjusting to the urostomy bag has been challenging. Are there better alternatives or tips to improve his comfort? We want to make informed decisions, but feel overwhelmed.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

If lymph nodes are positive, that means it is stage 3 or stage 4 bladder cancer. He needs adjuvant chemotherapy and immunotherapy. Radiotherapy is also an option if there is any residual disease pathologically. You have not shared the pathology report of the tumor, not what kind of cancer it was pathologically. Was it squamous cell carcinoma or urothelial cell carcinoma? Fatigue is common after such major surgery.

Mild swelling in the legs may also be due to this major surgery and lymph node dissection. Adjusting to a urostomy is challenging initially. But slowly, the patient will learn to adjust and manage it. PET (positron emission tomography) scans and MRIs (magnetic resonance imaging) are the best tools. But usually, a PET scan is not advised for at least four weeks after surgery. Overall, it has a high risk of recurrence, and the patient should be offered immunotherapy and chemotherapy to decrease the risk of recurrence.

I hope this information will help you.

Thank you.