According to the American Cancer Society, an estimated 81,400 people in the United States will be diagnosed with bladder cancer in 2020.
Urothelial carcinoma is the most common type of bladder cancer. When it spreads beyond the bladder, it can be referred to as metastatic urothelial carcinoma (mUC).
Receiving an advanced bladder cancer diagnosis can feel overwhelming. Keep in mind that treatments are available for every stage of bladder cancer.
Treatment options for advanced bladder cancer may differ from those of early-stage cancer.
The type of treatments your doctor recommends will also vary based on where the cancer has metastasized in the body. That’s why it’s important to discuss your options with your doctor.
Here are some questions to ask your doctor about treating advanced bladder cancer.
If your doctor believes that the cancer has metastasized to the lymph nodes or other organs, they’ll likely recommend several tests to determine the stage of the cancer and locate where it’s spread.
When initially diagnosed, your doctor may have performed or ordered tests, including:
- a physical exam, to check for any lumps or other abnormalities
- a urinalysis sample, to check for cancer cells
- a cystoscopy, to look inside the urethra for abnormalities
- a biopsy, to remove a sample piece of tissue from the bladder to test for cancer
- an intravenous pyelogram, or a type of X-ray to help determine where the cancer is located
When bladder cancer spreads, your doctor may order additional tests, such as:
- imaging scans, like a CT scan, MRI scan, or PET scan, to identify the location of cancer cells
- a bone scan, if you’re having unexplained joint pain, to determine whether the cancer has spread to the bones
- an X-ray, if you’re experiencing respiratory symptoms, to look for cancer cells in the lungs
Your doctor will recommend a treatment plan based on the stage of the cancer. Advanced or metastatic bladder cancer has fewer treatment options than earlier stages of bladder cancer. Your options may include:
The first-line treatment for advanced bladder cancer is the chemotherapy drug cisplatin, which can help stop cancer cells from reproducing.
Your doctor might recommend chemotherapy alone or in combination with surgery or radiation. Chemotherapy can kill some of the cancer cells and shrink tumors, making it easier to remove the cancer during surgery.
Depending on the extent of the cancer, after completing chemotherapy, your doctor may recommend a surgical procedure called cystectomy to remove all or part of the bladder.
In a cystectomy, after the bladder is removed, the surgeon will do another procedure called urinary diversion. They’ll create a reservoir inside the body to collect urine and then create a new tube so that urine can exit the body.
After surgery, your doctor may recommend additional chemotherapy to remove any remaining cancer cells.
Along with chemotherapy and surgery, advanced bladder cancer may respond to immunotherapy. This type of treatment uses your own immune system to fight the cancer.
Participating in a clinical trial can provide you with access to new experimental treatments. However, clinical trials also have risks. The experimental treatment may have unknown side effects, and it may not be effective.
If you’re interested in learning more about clinical trials, ask your doctor. They can talk to you about whether you might be a good candidate. They may also have information about how to access clinical trials for your condition.
Treatments for bladder cancer have important benefits, including prolonging life and improving your quality of life.
However, treatments also have side effects. It’s important to be aware of the side effects and talk to your doctor about ways to manage them.
Chemotherapy doesn’t just kill cancer cells. It also kills healthy cells. As a result, common side effects of chemotherapy include:
- hair loss
- an increased risk of infection
Surgery comes with certain risks, such as infection and blood loss.
Immunotherapy can have a range of side effects, depending on the type of immunotherapy used. The most common side effects include:
Some people also develop flu-like symptoms with immunotherapy.
Treatment options for advanced bladder cancer vary from person to person. The length of treatment depends on the overall treatment goals.
In general, most people with advanced bladder cancer receive chemotherapy for 6 to 12 months, depending on how long it takes to reduce cancer cells.
The length of time for immunotherapy also varies depending on the stage of cancer and how your body reacts to treatment.
For example, you may receive treatment every day for 2 or 3 weeks and then take a rest period before restarting treatment.
Treatment can prolong life for people living with advanced bladder cancer. However, in many cases, the disease tends to progress.
Your doctor may recommend that you continue to receive treatment to improve your quality of life.
As the cancer progresses, your doctor may suggest palliative care. You can continue treatment for the cancer while also receiving palliative care, notes the Bladder Care Advocacy Network (BCAN).
Palliative care is aimed at addressing the physical, emotional, and social aspects of the condition.
It can treat specific physical symptoms, such as nausea and fatigue. It can also help improve your overall quality of life and help you manage stress related to the condition.
There’s currently no cure for metastatic bladder cancer. For bladder cancer that’s spread to distant areas of the body, the 5-year survival rate is 5 percent, according to the National Cancer Institute.
The goals of treatment at this stage are usually to:
- slow the spread of the cancer
- shrink the size of the affected areas
- extend your life as long as possible
- make you comfortable
In general, health insurance plans cover cancer treatments, but they may not cover the entire cost. Different plans may cover different amounts, and some may not cover certain types of treatment, especially experimental treatments.
For example, your health insurance policy will likely cover the cost of:
You may have a deductible, which is an amount you pay out-of-pocket before your insurance covers the bill.
Some insurance policies don’t cover immunotherapy.
To receive this type of treatment, your insurance provider may have to approve this therapy. Talk with your health insurance company to better understand your specific coverage.
If you participate in a clinical trial, your insurance company will likely cover things like your usual doctor visits.
The trial itself will usually cover the cost of the experimental treatment, any additional doctor visits, or any testing that needs to be done as a part of the study.
Along with following a treatment plan, certain lifestyle changes can make living with advanced bladder cancer a little easier. Even with limited strength and energy, there are some things you can do to feel better.
For example, eating a healthy, balanced diet can help you maintain your physical strength and boost your immune system.
A stronger immune system can help your body fight off infections, which is especially important while you’re in treatment.
Some people find dietary supplements helpful while receiving treatment for cancer. Be sure to talk with your doctor before taking dietary supplements.
Staying physically active is also important. Exercise can help:
- improve your mental outlook
- improve the quality of your sleep
- increase your energy level
If you smoke, and you haven’t already, you should also quit smoking. The chemicals found in both cigarette and cigar smoke can accumulate in your urine and cause further damage to your bladder.
A diagnosis of advanced bladder cancer can come as a shock.
However, treatment can help:
- shrink tumors
- prolong your life
- improve your quality of life
It’s important to work with your doctor and discuss your options. Make sure you understand the side effects of each treatment, as well as what you can expect before, during, and after treatment.