The main goal of treatment for any metastatic cancer is to slow down the cancer’s growth and progression. Often, this will reduce symptoms and prolong life.

There are relatively few treatments for bladder cancer once it has become metastatic. However, many treatments can help manage the side effects and symptoms, especially pain. A medical oncologist can help patients develop the best treatment plan possible. The two most common treatments for stage 4 bladder cancer are chemotherapy and surgery.

Chemotherapy is any treatment of a disease that involves chemicals. Many diseases are treated with chemotherapy, but the most common disease is cancer. Chemotherapy can be given as a liquid, tablet, or capsule you take by mouth. It can also be given intravenously through an IV. Both of these allow the drug to enter the bloodstream and target cancer cells at the original site and wherever the cancer has spread.

There are two types of chemotherapy: classic and targeted.

Classic chemotherapy

Classic chemotherapy has been around for a while and traditionally used in cancer treatment. It’s cytoxic, which means it kills cells, especially cells that are growing and dividing quickly, like cancer cells. But since it goes after all fast-growing cells, classic chemotherapy can also kill healthy cells. This includes hair follicles, cells in the bone marrow, and cells that line the digestive tract. The killing of these healthy cells is what causes the typical sides effects of chemotherapy, including:

  • hair loss
  • decreased blood cell production
  • suppression of the immune system
  • gastrointestinal symptoms, such as constipation and diarrhea

Targeted therapy

Newer chemotherapy drugs can better target specific cells, particularly cancer cells. These chemotherapy drugs are often called “targeted therapy.” These drugs can target proteins or enzymes created by the cancer cells to block growth or decrease the chance of spread. Other targeted therapy drugs help the immune system kill cancer cells. Because these treatments specifically target the cancer cells, they tend to have fewer side effects than classic chemotherapy.

While chemotherapy is often the first line of treatment for bladder cancer, other types of treatments may be used for bladder cancer. Not every treatment is right for every patient. Other options to treat bladder cancer and associated symptoms include:

  • radiation therapy
  • surgery
  • clinical trials
  • pain management
  • palliative care

Radiation therapy uses strong X-rays or other types of radiation. It can kill cancer cells and stop them from growing. Radiation can be focused on the area of the body where the cancer is. Or it can be inserted into or near the tumor to allow a longer term of exposure. Radiation is most useful when the cancer is located in a small contained area, which can make it difficult to use in stage 4 bladder cancer.

In most cases, surgical treatment for stage 4 bladder cancer will not successfully remove all of the cancer or improve your life expectancy. But it can help to reduce symptoms and slow the spread of your cancer. Lymph nodes that have become cancerous can also be removed with surgery.

When treating invasive bladder cancer surgically, all or part of the bladder may need to be removed. This surgery is called a cystectomy. Depending on how advanced the cancer is, parts of nearby organs or tissues may need to be removed too. Surgical reconstruction options are available for people who have a cystectomy. It’s important to understand the goal of surgery for your stage 4 bladder cancer before you decide on having surgery.

Clinical trials are research studies involving new drugs or therapies that aren’t yet FDA-approved or available to the general public. These trials have been approved for human research and are regulated with rules and guidelines. They’re generally regarded as safe, but they may come with certain risks, side effects, or long-term effects. If you decide to participate in a clinical trial, you must be informed of these risks. You also have the right to drop out of the trial at any time.

It’s important to remember that every treatment option available went through a clinical trial. By participating in a trial, you can help test new treatments and bring them to market for other patients.

One of the biggest parts of treating metastatic cancer is treating the side effects, especially pain. Proper pain management can improve your quality of life. There are many different types of pain and management options. Talk to your doctor early on about any pain you feel and which treatment option is right for you.

The goal of palliative care is to prevent and treat the symptoms and side effects of an illness as early as possible. People with stage 4 cancer should not only treat their cancer, but also take care of their body, mind, and spirit. Palliative care teams are made up of doctors, nurses, pharmacists, psychologists, social workers, and other healthcare professionals. They can help you to define and communicate your goals of care. They can also help your oncology team manage uncontrolled pain and other physical symptoms of your cancer, as well as the emotional, psychological, and social aspects.

Ideally, palliative care should begin when your cancer is diagnosed and you start receiving treatment. But it’s especially important if you decide to stop cancer treatments. When started early, palliative care has been shown to increase a person’s quality of life while living with cancer.