Advanced bladder cancer treatment

Palliative treatment options

If bladder cancer has spread to other parts of the body, it is known as advanced or metastatic bladder cancer. Treatment will focus on controlling the cancer and relieving symptoms without trying to cure the disease. This is called palliative treatment.

Many people think that palliative treatment is only for people at the end of their life, but it may help people at any stage of advanced bladder cancer. It is about living as comfortably as possible and helping you to maintain your quality of life.

Palliative treatments may include:

• systemic chemotherapy 
• immunotherapy 
• antibody-drug conjugates
• surgery – various types may be used (TURBT or cystectomy)
• radiation therapy.

Immunotherapy (checkpoint inhibitors)

Immunotherapy uses the body’s own immune system to fight cancer. A group of immunotherapy drugs called checkpoint inhibitors work by letting the immune system recognise and attack the cancer.

After a course of chemotherapy, some people with advanced bladder cancer may have checkpoint inhibitor drugs. These drugs are given directly into a vein through a drip (infusion) and the treatment is repeated every 2–6 weeks. How many infusions you receive will depend on how you respond to the drug.

Side effects of immunotherapy 

Like all treatments, checkpoint inhibitors can cause side effects. Because these drugs act on the immune system, they can sometimes cause the immune system to attack healthy cells in any part of the body. This can lead to various side effects including skin rash, diarrhoea, breathing problems, inflammation of the liver, hormone changes, joint pain and temporary arthritis, and other problems. Your doctor will discuss possible side effects with you.

Antibody-drug conjugates

A new type of drug called an antibody-drug conjugate (ADC) may be used. ADCs combine chemotherapy with targeted therapy. The targeted therapy targets specific features of cancer cells to stop the cancer growing and spreading.

An ADC may be used for cancer that has not responded to other types of chemotherapy and immunotherapy. It may also be used before cystectomy (neoadjuvant therapy). An ADC is given in the same way as systemic chemotherapy.

Side effects of ADCs

These may include skin rashes; nausea and vomiting; high blood sugar; shortness of breath or trouble breathing; or eye problems such as blurred vision. Let your treatment team know if you notice these or any other side effects.

Radiation therapy

Radiation therapy can be used when the bladder cancer is advanced or has spread from the bladder to other areas in the body.

Palliative radiation therapy can be used to shrink the cancer in the bladder, to stop bleeding in the bladder and to help with pain that the cancer may be causing. It can also be directed at other parts of the body for symptoms such as pain from cancer that has spread to the bones.

The number of radiation therapy treatments needed ranges from a single treatment to several weeks of daily treatments. Each treatment session takes about 10–15 minutes.

Side effects of radiation therapy – The potential side effects willdepend on which part of the body is being treated, but are usually mild.

Palliative care

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, social and spiritual needs. The palliative care team will work with your cancer specialists to manage side effects from treatment. The team also provides support to families and carers.

Learn more about palliative care and living with advanced cancer.