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Metastatic Bladder Cancer

The bladder is a flexible, hollow organ that is mostly made of muscle, but it has a thin layer of cells lining the inside of the bladder walls called the urothelium. In most patients with bladder cancer, the cancer cells started to grow in this inner lining of the bladder. As the number of cancer cells grows, they can form a mass called a tumor.1,2

When bladder cancer spreads to other parts of the body

When cancer cells break away from where they started to grow and start spreading to other parts of the body, it is called metastasis. Metastatic bladder cancer is the name for bladder cancer that has spread to other parts of the body, such as the lungs, the liver, or the bones. Even if the cancer cells are first discovered in the bones, for example, if they first started growing in the bladder it is still called metastatic bladder cancer.1

Symptoms of metastatic bladder cancer

Common symptoms of metastatic bladder cancer include:1,3

  • Blood in the urine
  • Frequent urination
  • Pain or burning during urination
  • Need to urinate despite an empty bladder
  • Being unable to urinate
  • Lower back and abdominal pain
  • Swelling in the feet
  • Fatigue and weakness
  • Decreased appetite and weight loss
  • Bone pain

Let your doctor know right away if you are experiencing these symptoms. If your doctor thinks your symptoms may be caused by bladder cancer, you will need to have tests performed.

How is bladder cancer diagnosed?

A cystoscopy is the main test used to identify and diagnose bladder cancer. During the procedure, a cystoscope (lighted telescope) is inserted into your bladder from the urethra so your doctor can view the inside of your bladder. If the procedure is done under anesthesia, your doctor can also take a biopsy (tissue samples) so they can examine it for signs of cancer. If the tests find cancer cells or tumors in the bladder, then more tests will likely be needed to find out if there are bladder cancer cells in other parts of the body.3

Transurethral resection of a bladder tumor (TURBT)

A procedure called transurethral resection is commonly used to learn more about the bladder cancer. This procedure is often also part of treatment for early-stage or non-muscle invasive bladder cancer. During this procedure, a telescope is inserted into your bladder, and the tumor is then removed by scraping it from the bladder wall. Other tests may include a CT scan of the abdomen and pelvis, MRI scans, X-rays, and bone scans.3

Treating metastatic bladder cancer

Treatment for metastatic bladder cancer is different for each person, depending on your specific situation. Your doctor and care team will discuss different options with you, as well as the advantages and disadvantages of each type of treatment option.

The goals of most types of treatment are to slow down how fast the cancer cells are growing and to shrink the tumor as much as possible. Other important goals of treatment are to help people with bladder cancer live as long as possible and to make sure they have the best possible quality of life. Palliative care can also help relieve symptoms and treatment side effects.4

Chemotherapy

Treatment for metastatic bladder cancer may involve a combination of chemotherapy treatments with or without surgery or radiation. Systemic chemotherapy is typically used as first-line treatment for metastatic bladder cancer, but this can vary for each person. Systemic means the chemotherapy drugs target the cancer cells, but all of the cells in your body are also exposed to the medicine. These drugs help stop or reduce the growth of cancer cells throughout the body.1,5

A combination of chemotherapy drugs usually works better than 1 drug alone. Different systemic chemotherapy drugs are available. Some are being tested in clinical trials to find out which drugs or combination of drugs work best to treat bladder cancer.5

Immunotherapy

Immunotherapy may also be used as a treatment for metastatic bladder cancer. There are currently 5 immune checkpoint inhibitors that have been approved by the U.S. Food and Drug Administration (FDA) to treat certain forms of metastatic bladder cancer, with specific uses defined for each individual drug. Other immunotherapy drugs for metastatic bladder cancer are being studied in clinical trials.4,5

Systemic therapy with immune checkpoint inhibitors is used for certain forms of metastatic bladder cancer. This is a type of immunotherapy that works throughout the entire body by blocking a protein that stops the immune system from destroying cancer cells. By blocking this protein, the immune system is better able to eliminate cancer cells.4,5

Targeted therapy

Targeted therapy drugs work by targeting specific genes and proteins that are involved in the growth and survival of cancer cells. In general, targeted therapy drugs can destroy cancer cells, prevent cancer cells from living longer than normal, and/or block or turn off signals that tell cancer cells to grow.5

To find the best targeted therapy, your doctor will perform tests to identify the genes, proteins, and other factors in your tumor. This helps your doctor match you with the most effective treatment when possible.5

Clinical trials

Some people with this type of bladder cancer may choose to take part in a clinical trial for new types of cancer treatments. Clinical trials evaluate new drugs, different combinations of treatments, new approaches to radiation or surgery, as well as new treatment methods. Some also study new ways to relieve symptoms and side effects of cancer treatment.5

Your doctor and healthcare team can provide more information about whether you are eligible to take part in a clinical trial.

Palliative care

Bladder cancer and its treatments cause a number of physical symptoms and side effects, along with emotional, social, and financial effects. Palliative care is an important part of your treatment plan that is used to manage all of these effects.5

Palliative care focuses on improving how you feel during treatment by managing your symptoms or treatment side effects. Your palliative care team also works to support you and your family with other non-medical needs, including your nutritional needs and spiritual support. People who receive palliative care as part of their cancer treatment plan often have less severe symptoms and better quality of life.5

Palliative care for metastatic bladder cancer may include treatments such as radiation, surgery, or certain medicines. These treatments may help relieve symptoms and improve quality of life, but these treatments do not focus on curing the disease or prolonging life.1,5

What is the prognosis for metastatic bladder cancer?

Most people with metastatic bladder cancer cannot be cured. The 5-year relative survival rates for people with distant bladder cancer, meaning the cancer has spread to distant parts of the body such as the lungs, liver, or bones, is about 5 percent. This means that people with metastatic bladder cancer are, on average, about 5 percent as likely as people who do not have this form of cancer to live for at least 5 years after being diagnosed.1,5

However, there are treatments available that can help some people with metastatic bladder cancer to live longer and improve their quality of life.1

Talk to your doctor

Being diagnosed with metastatic cancer can be very upsetting and stressful, but your doctor and care team are there to help. Talk with them about how you and your loved ones are feeling about your diagnosis. They can offer you support and guidance about how to deal with your feelings and fears. Many people also find support groups for people with bladder cancer and their families to be helpful, because there are many other people also coming to terms with the same types of emotions.

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<span id="review_comment"> Written by Anna Nicholson & Heather Morse | Last review date: November 2020 </span>