What to Know About Metastatic Bladder Cancer

Bladder cancer affects around 56,000 men and 17,500 women in the United States each year.

It typically starts in cells that line the inside of the bladder. When bladder cancer cells spread into other areas of the body, it becomes metastatic bladder cancer.

If you've been diagnosed with metastatic bladder cancer, it's understandable to feel overwhelmed and uncertain. However, there's treatment available to help manage symptoms and slow disease progression.

In this article, we'll go over symptoms, treatments, and the prognosis you can expect with metastatic bladder cancer.

Where Bladder Cancer Can Spread

The bladder is a hollow organ that holds urine. It has flexible walls that are composed of several layers. When bladder cancer starts to spread, it grows through each layer of the bladder wall.

When cancer cells continue to grow outside the bladder wall, they may migrate into surrounding organs or lymph nodes. Once cancer cells are in the lymphatic system, they can metastasize anywhere in the body. Common locations where bladder cancer may spread include:

• Bones
• Lungs
• Liver
• Peritoneum (tissue that lines the inside of the abdomen)
• Pelvis

No matter where bladder cancer spreads, it's still considered bladder cancer.

Symptoms and Complications

The first symptom of bladder cancer is usually blood in the urine. However, it’s possible to have blood in your urine and not see it. Laboratory testing can identify blood in urine, even when it’s not visible to the eye. As bladder cancer spreads, you may experience other symptoms, too. Advanced bladder cancer symptoms include:

• Trouble urinating
• Lower back pain that may center on one side of the body
• Bone pain or weakness
• Swollen feet
• Weakness and fatigue
• Loss of appetite and weight loss
  

Metastatic bladder cancer can cause complications. These vary based upon where your cancer has spread. Advanced bladder cancer complications may include:

• Erectile dysfunction in people with penises
• Sexual dysfunction such as loss of desire and pain during sex in people with vaginas
• Anemia (low iron)
• Urinary incontinence (inability to hold urine)
• Urinary tract infections (UTIs) or inflammation
  

Treatment Options

Treatments for metastatic bladder cancer can vary, based on things like how extensively your cancer has spread, your overall health and strength, and your current symptoms.

Your healthcare provider may recommend one or more treatment options for you.

Chemotherapy

Chemotherapy is the standard first-line therapy used for metastatic bladder cancer. Systemic chemotherapy is often used as a treatment for any type of cancer that's spread. Systemic chemotherapy targets cancer throughout the body, rather than one localized area. It works by shrinking, slowing down, or stopping the growth of cancer cells.

Chemotherapy may be done alone or with radiation. Radiation is used to reduce some of the symptoms and side effects that negatively impact your quality of life. These include:

• Bone metastases (bone pain or breakage)
• Urgent, nocturnal, and frequent urination
• UTIs
  

There are many different chemotherapy drugs. The ones usually used for metastatic bladder cancer are platinum-based chemotherapy drugs. These are often administered via injection into a vein.

Surgery

Surgery isn't a first-line treatment for metastatic bladder cancer. However, if cancer cells remain in the bladder after chemotherapy, a cystectomy may be recommended.

Cystectomy is the surgical removal of some or all of the bladder. This procedure won’t target cancer cells that have spread to other parts of the body. It may, however, be beneficial for slowing down or stopping a recurrence.

Immunotherapy

Immunotherapy may also be recommended as a second-line treatment after chemotherapy. Immunotherapy uses biologics to boost your immune system.

Biologics are drugs made from proteins or living cells. This type of treatment may help delay cancer progression and extend life expectancy.

Targeted Therapy

If you're not a candidate for chemotherapy, or you become resistant to chemotherapy drugs, your healthcare provider may recommend targeted therapy for you.

Targeted cancer therapy utilizes drugs and other substances to block the growth and spread of cancer cells. It works by targeting the specific molecules that support the growth and spread of cancer cells.

Research into metastatic bladder cancer is vigorous and ongoing. Talk with your healthcare provider about clinical trials that may be beneficial for you.

Living With Bladder Cancer

Bladder cancer symptoms and treatments can be overwhelming. No matter where you are on your treatment journey, you’ll need to meet with your healthcare provider for regular checkups and tests. Talking to your healthcare team about the next steps and what to expect can provide a road map during this time.    

 Joining a support group of people dealing with advanced cancer may help provide camaraderie and knowledge. You can connect with people who understand what you're going through.

Treating cancer means looking after your whole self. This includes keeping an active lifestyle, eating healthy, practicing mindfulness, and socializing with family and friends to improve your mood and overall health. If you smoke cigarettes or use nicotine products, this is a good time to try to quit or cut down.

It's also important to look after your mental health. Meeting with a therapist can help you navigate intense emotions and provide you with tools to feel more in control of your daily life.

Palliative care may also be beneficial. Your palliative care provider can help you learn about pain management options. Palliative care providers can also assist with finding mental health services, such as counseling.

Prognosis

Metastatic bladder cancer is a challenging diagnosis. Your health, strength, and age will all play a role in your prognosis. How well your cancer responds to treatment is also a significant factor.  

Talk to your healthcare provider about your specific prognosis, and what you can expect. In many instances, treatments after chemotherapy can help prolong life and improve quality of life. These include radiation and immunotherapy.

The five-year relative survival rate for people with metastatic bladder cancer is around 6%. This figure is only an estimate. It doesn’t account for individual differences that might impact longer-term survival, including participation in clinical trials.

Summary

Metastatic bladder cancer is cancer that has spread outside of the bladder to other parts of the body. If you have metastatic bladder cancer, your treatment will be focused on destroying or slowing down cancer cells throughout your body, not just in your bladder.

There are several treatments for this disease. Chemotherapy is usually the first-line treatment your doctor may recommend. After chemotherapy, systemic treatments can help reduce cancer progression and prolong life, plus alleviate symptoms such as pain.

Metastatic bladder cancer is a challenging diagnosis. During and after treatment, you may benefit from connecting with others who have this disease. Maintaining a healthy lifestyle and a positive attitude may also help.

A Word From Verywell

A diagnosis of metastatic bladder cancer can feel overwhelming, but there's treatment to help manage symptoms and slow disease progression. No matter where you are on your treatment journey, it's important to maintain regular appointments with your healthcare provider to keep your cancer under control.

Joining a cancer support group can help you feel less alone. Here, you can connect with people who understand what you're going through. Talking openly with a mental health professional about how you're feeling can also provide a sense of comfort.