If you have advanced bladder cancer, cancer cells have broken off from a tumor in your bladder and are now in other parts of your body. You might also hear this called metastatic cancer. Metastasize means "to spread."
Advanced bladder cancer can be a challenge to treat. Your doctor will try to slow down the progress of the disease, help reduce your symptoms, and make you more comfortable.
There's no "best" treatment for advanced bladder cancer. Everyone's cancer case is different. When choosing your treatment plan, your doctor will factor in things like:
- Your health
- Other bladder cancer treatments you've had
- Possible treatment side effects
- Genetic testing results
- Your preferences
Chemotherapy
Chemotherapy drugs destroy the cancer cells in your body. This is a common way to treat advanced bladder cancer.
To get chemotherapy, you'll sit in a clinic or hospital for a few hours while medication is given to you through a vein in your arm (IV). Most oral chemotherapies can be taken at home. Based on your treatment plan, you may get IV chemotherapy at home with the help of a home health infusion nurse.
Your doctor can give you a drug that combines chemotherapy with another type of cancer therapy. For instance, enfortumab vedotin-ejfv (Padcev) is an antibody-drug conjugate (ADC). It combines a chemotherapy drug with a monoclonal antibody, a drug that helps "break into" and destroy cancer cells more easily.
Chemotherapy can cause many different side effects. Your doctor can help you manage them. In some cases, they may decide to change your medication or dose, or stop chemotherapy and try a different treatment.
Radiotherapy
Beams of high-powered energy, like X-rays, are a powerful way to damage cancer cells. This type of cancer treatment has been used for over 100 years.
When you have advanced bladder cancer, radiotherapy can also help with symptoms like:
- Pain
- Bleeding
- Urine problems like needing to pee all the time or not being able to pee
The most common kind of radiation is external beam radiation therapy (EBRT). If you have it, you'll go into a room with a very large machine called a linear accelerator. You'll lie down and stay still while rays of energy are aimed at a certain part of your body.
The machine doesn't touch you. You won't feel the radiation going into your body.
A session can last from 10 to 30 minutes. Then, you can go home.
If you need more than one radiation session, they'll be spread out so the healthy cells in your body have time to recover.
Targeted Therapy
This type of medication can destroy special proteins, or "targets," inside or on cancer cells. That prevents them from growing and spreading.
Small molecule drugs are tiny enough to sneak inside cancer cells and kill proteins that way. Most of these medications come in a pill that you swallow.
Monoclonal antibodies can work a few different ways. Some put a target on cancer cells so your immune cells can spot them more easily. Others destroy cancer cells. Monoclonal antibodies are given to you through an IV.
Before you have targeted therapy, your doctor will send a sample of your tumor to a lab. Special tests can show which biomarkers it contains.
Biomarkers are very specific proteins. If there's a drug that matches your biomarkers, it will be able to gain access to – and destroy – your cancer cells.
Immune-Based Therapies
These drugs help your immune system work smarter and harder to attack cancer cells. ADCs are one type. Another kind that's useful in treating advanced bladder cancer is checkpoint inhibitors.
Your T cells are your immune system's "fighter cells." Cancer cells are able to slip by them because special "checkpoint" proteins are switched off. Checkpoint inhibitors turn them on. That makes your T cells "see" the cancer cells and go after them.
Checkpoint inhibitors are usually given by IV. You'll probably get them along with another drug.
A large study found that the ADC enfortumab vedotin-ejfv (Padcev) and a checkpoint inhibitor called pembrolizumab (Keytruda) could slow cancer spread better than traditional chemotherapy. It was also better at shrinking tumors. Because it works so well, this may be the first treatment your doctor tries.
You could also get checkpoint inhibitors after chemotherapy if your cancer comes back.
Radical Cystectomy
This is a major surgery that removes your bladder. It could be done if the cancer:
- Is growing fast
- Has spread through your bladder wall
Your nearby lymph nodes and organs may need to be removed too.
If you're assigned male at birth, your doctor could take out your:
- Prostate
- Seminal vesicles, glands that help you make semen
If you're assigned female at birth, your doctor may take out your:
- Uterus
- Ovaries
- Fallopian tubes
- Part of your vagina
A radical cystectomy can be done with different techniques. Your bladder could be taken out through an incision (cut) in your lower belly. Robot-assisted surgery is also an option. That type is minimally invasive, meaning that you'll have a smaller scar.
Once your bladder is out, your surgeon will build you a new urinary tract. That's done by using part of your intestines.
A radical cystectomy can take six hours to finish. You'll get anesthesia so you stay unconscious (asleep) and don't feel any pain during the procedure.
Like any major surgery, the recovery can be long. Your doctor will need to make sure the benefits to you are greater than the risks.
Clinical Trials
When other treatments haven't helped, you might join a clinical trial. This type of medical research relies on volunteers to try out new treatments for conditions like advanced bladder cancer.
You could be asked to test:
- New medications
- Current medications that are being used for different purposes
- New combinations of drugs
- Changes to your behavior or lifestyle
- Medical devices
- Surgeries
- Other therapies
Clinical trials happen all over the U.S. Taking part could give you access to a new, useful treatment. You might also get more care for your condition and symptoms, at no extra cost.
If you'd like to be part of a clinical trial, talk to your doctor. They can help you find one that's a good fit.
Show Sources
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SOURCES:
Joaquim Bellmunt, MD, PhD, director, Bladder Cancer Center, Dana-Farber Cancer Institute, Boston.
Ashish Kamat, MD, MBBS, president, International Bladder Cancer Group (IBCG); professor of urologic oncology (surgery); Wayne B. Duddlesten professor of cancer research; director, bladder cancer research; director, Patient Support Center, University of Texas MD Anderson Cancer Center Department of Urology, Houston.
Future Oncology: "Enfortumab vedotin and pembrolizumab: redefining the standard of care for previously untreated advanced urothelial cancer."
City of Hope: "Metastatic Stage 4 Bladder Cancer."
Cancer Research UK: "Radiotherapy for Metastatic Bladder Cancer," "Chemotherapy for Metastatic Bladder Cancer," "Checkpoint Inhibitors."
Cleveland Clinic: "Radiation Therapy," "Cystectomy."
Mayo Clinic: "Radiation Therapy."
American Cancer Society: "Chemotherapy for Bladder Cancer," "Immunotherapy for Bladder Cancer."
National Cancer Institute: "Targeted Therapy to Treat Cancer."
National Institutes of Health: "Clinical Research Trials and You: The Basics."
Memorial Sloan Kettering Cancer Center: "Bladder Cancer Surgery, Cystectomy, Preservation, and Diversion."
Padcev.com: "What is Padcev?"
