- WebCafé home
- Newly Diagnosed
- Treatment Options
- Non-Invasive blc
- Invasive bladder cancer
- Upper tract TCC
- Metastatic cancer
- Clinical trials
- Survival Guides
- Resources USA & Canada
- Resources Europe
- Clinical trials
- Alternative medicine
- Financial help
- About Us
|Metastatic Bladder Cancer|
Diagnosis, symptoms and treatments for common metastases
Metastatic cancer in all its many forms is a formidable foe. Metastatic cancer ('mets') means that cancer cells have traveled through the bloodstream or lymph system to form a secondary tumor of the same biological make up. Only 5% of people have metastases when their bladder cancer is discovered.
Transitional cell carcinoma of the bladder and/or upper urinary tract most commonly mestastasizes to the lymph nodes, lung, bone, liver and brain, although it can appear almost anywhere. Treatments for metastatic bladder cancer vary according to the site of spread, prior therapies and the needs of individual.
If someone is diagnosed as having lymph node or involvement or tumor outside the bladder, the option of cystectomy may be withheld (not considered worth the morbidity or the costs).
Metastatic disease is considered incurable; however a subset of patients who have stage IV disease which is local, or 'regional', such as minimal extension to pelvic organs or small volume metastases to regional lymph nodes may benefit from cystectomy with or without adjuvant chemotherapy or radiation. Chemotherapy or radiation are the treatments of choice, as well as cystectomy with an ileal conduit for palliation of symptoms.
For the NCI treatment summaries for Stage IV, metastastic or recurrent bladder cancer, click here Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and gemcitabine. Molecular targets are being investigated and are of interest to those looking for options; One ongoing phase I/II trial using Herceptin plus Taxol chemotherapy appears like a hopeful option for those with Her2-overexpressed, metastatic TCC. Paclitaxel and Radiation Therapy With or Without Trastuzumab in Treating Patients Who Have Undergone Surgery for Bladder Cancer
Benefits from treatments include control of symptoms and possible prolongation
of life. The most important concerns are:
For help finding a second opinion click here
Because the needs of metastatic patients are highly individual and many
of the treatments are still experimental, there are no standard guidelines
available to either the patient or the doctor. In some cases the decision
is determined by whose opinion you seek a surgeon will recommend
surgery, an oncologist chemotherapy or a radiation oncologist radiation
therapy. Often, the patient and family must decide on the course
of treatment. .
Diagnosis, symptoms and treatments for common metastases
Many times metastasis first makes its presence known by causing symptoms. These symptoms differ according to the site of spread and how far advanced the cancer is.
In cases where regional (pelvic) lymph nodes are found to be involved either before or during surgery many experts feel that surgical removal of these nodes can actually be curative. For more info here at WebCafe see: Survival Advantage with Lymph Node Removal
If lymph nodes metastasize after surgery has been done, chemotherapy and/or radiation is preferred over further surgery as the disease is now considered systemic. In some cases, chemotherapy can gain significant periods of disease-free survival.
A presentation at the 2005's American Urological Association's meeting discusses the usefulness of further chemo following neo-adjuvant (pre-op) chemo, cystectomy and lymph node involvement found after surgery. See the abstract here
Surgery may be an option in certain cases (preferable one small lesion or tumor). Studies have shown that the used of combined modalities (ie: surgery+chemo and/or whole brain radiation) give better results than single mode therapy. One study showed that younger age, single metastasis, surgical resection, whole brain radiation therapy, and chemotherapy were associated with prolonged survival. Stereotactic radiosurgery (the 'gamma knife') is sometimes used, though few institutions have the equipment.
More info can be found on the Memorial Sloane Ketting Cancer Center site, covering symptoms, diagnosis and treatments: Metastatic Brain Tumors
Metastatic bone lesions can be described as osteolytic, osteoblastic and mixed. The osteolytic lesions are most common where the destructive processes outstrip the laying down of new bone. Osteoblastic lesions result from new bone growth that is stimulated by the tumor. Microscopically, most lesions are mixed.
Treatment for bone metastasis is normally palliative. An assessment of the risk of pathological fracture must be made by an experienced orthopaedic surgeon. Lesions that do not represent a risk for fracture may be treated with radiation or by appropriate chemotherapy directed at the tumor.
Where a weight-bearing bone, such as the leg is involved, your doctor
may suggest an operation to support the bone and prevent a break. This
procedure will involve reinforcing the bone with internal splints and
may help relieve pain and prevent a break. The goals of surgery are to
preserve stability and function of the musculoskeletal system as well
as alleviate pain.
For an article with everything you wish you never needed to know about
bone metastases: http://www.emedicine.com/radio/topic88.htm#section~mri
Zometa, the youngest and easiest to use of the bisphosphonates, was first approved for the treatment of hypercalecemia. In February, 2002, The FDA approved Zometa (Zoledronic Acid) for patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy. The trials that led to the approval of Zometa mark the first time any bisphosphonate has demonstrated efficacy in treating bone complications in patients with prostate cancer, lung cancer and other solid tumors (including bladder tumors). see; http://www.zometa.com/index.html
One potential potential side effect of Zometa included kidney damage,
which can also occur with other bisphosphonates.
This is relatively new procedure which can relieve pain and strengthen the spinal column if it has been damaged by tumor spread. A cement-like substance is inserted into weak or fractured vertebrae. Pain relief and increased mobility usually occur within a week. Treatments may be done on an outpatient baisis using conscious sedations.
Radiofrquency ablation for bone metastates and other disseminated
Radiofrequency ablation is an outpatient procedure whereby a small needle electrode is placed directly into the tumor using CT scan or ultrasound guidance. The high frequency radiowaves sent into the tumor cause heating and local necrosis of the tumor. The procedure takes between 45-90 minutes and can be performed with intravenous sedation. This technique is currently being applied to tumors involving the liver), kidneys, pancreas, adrenal gland and skeleton.
Patient selection criteria are controversial for RFA, so check the protocols
on the NIH website or
have your doctor call 1-800-411-1222 to see if you qualify.
New avenues of treatment are being investigated: Molecular Therapies Target Bone Metastasis MD Anderson's Oncolog, Feb. 2002
Anemia is extremely common in patients with cancer.
Low hemoglobin levels are associated with diminished quality of life and
possibly decreased overall survival. Successful treatment of anemia has
undeniable benefits for patients, often yielding dramatic symptomatic
Because of the distinction in practice between active treatment and palliation at the end of life, defining selection criteria for end-of-life services assumes critical importance.
Unless patients and families hear that the likelihood of survival is declining so that informed decision-making can occur, aggressive treatment may proceed without regard to its potential futility, attendant physical and emotional distress, and high costs.
Prognostic estimates are necessary to determine hospice eligibility. In order to qualify for hospice, patients must be certified by their physician as "terminal," defined by law as "six-month life expectancy, assuming the disease runs its normal course."
Evidence indicates that many patients, even those with very advanced disease, begin to plan realistically only after they comprehend that their own survival may be limited. Only then can informed consent discussions be initiated in which the "forgotten option" - that of a well-managed end of life - may be introduced by the compassionate and skillful physician.
Many factors enter into the clinical assessment of patients with cancer who are under evaluation for end-of-life services. In general, the malignancy should be advanced, defined as stage IV with distant metastases, and progressive, with evidence of increased burden of disease and health care utilization. Usually conventional anticancer therapy has become ineffective, is being given for palliative reasons alone, or has been declined. In some cases, significant nonmalignant comorbid conditions make disease-directed therapy unrealistic. Frequently, the patient or family (or both) have chosen treatment goals focused on comfort and relief of suffering rather than life-prolonging therapy.
Many physicians believe that once therapeutic options have been exhausted,
nothing more can be done for patients with advanced disease. Unfortunately,
this attitude deprives patients, their families, and the physicians themselves
of the opportunity to find comfort and to experience the benefits of care
that, even if provided in the patient's home, may be as intensive as that
provided in the hospital. The key to a well-managed end of life is careful
attention to changing goals of treatment from curative to supportive early
enough in the disease process to allow patients and families the time
to benefit from palliative care. When events are managed well in alignment
with patient and family preferences, all participants may come to remember
the end of life as a time that can be challenging, but is often extraordinarily
Further Reading: July/Aug '00 issue of the Moffit Cancer Journal: Progress in the Management of Metastatic Bladder Cancer (PDF file: 129Kb] http://www.moffitt.usf.edu/pubs/ccj/v7n4/toc.htm
Advances in the Treatment of Metastatic Bladder Cancer Nicholas J. Vogelzang, MD -- Writer: Michelle L. Plante, PharmD, online article at Medscape, registering is required, then search for 'advances bladder' for the article.
The above section "When to Stop Treatment' was excerpted in part from the article "Advanced Cancer and Comorbid Conditions, Prognosis and Treatment' Brad Stuart, Cancer Control 6(2):168-175, 1999. © 1999 H. Lee Moffitt Cancer Center and Research Institute, Inc Selections from 1999 - Volume 6, Number 2 from Cancer Control: Journal of the Moffitt Cancer Center Used with permission from publisher.