Treating metastatic bladder cancer

What happens if the tumour has already metastasised?

If secondary tumours are already present in lymph nodes or other organs (lungs, bone) when the cancer is first diagnosed, or if microscopic examination of the tissue following radical bladder removal shows that the tumour has spread to distant lymph nodes, one option is systemic chemotherapy. This involves an intravenous infusion of cytostatic drugs (drugs that stop cells from growing) into the bloodstream. These drugs then attack all rapidly dividing cells. This includes tumour cells, but it also includes many other rapidly dividing normal cells. This is why chemotherapy has some fairly severe side effects. Particularly affected are hair follicle cells, intestinal cells and blood cells.

The old MVEC/MVAC protocol (named after the substances used) has nowadays been superseded by an equally effective combination of cisplatin and gemcitabine. The new protocol is much better tolerated, with fewer side effects, and is just as effective. As a result, it is generally possible to administer chemotherapy as an outpatient procedure. Modern drugs that are administered at the same time are also able to significantly reduce the side effects of chemotherapy.
If the disease continues to progress despite all of the treatment options used, other treatments are available. These include a recently introduced immunotherapy treatment using drugs known as checkpoint inhibitors.
These substances (atezolizumab, nivolumab or pembrolizumab) help the patient’s immune system to recognize and fight tumour cells. In some cases, these drugs can prolong survival considerably.

There are also other procedures aimed at relieving symptoms or complications of the disease. This includes surgery to remove individual metastases, to restore urinary function and to eliminate any sources of bleeding.