Late Stages of Bladder Cancer

Tens of thousands of people in the United States are diagnosed with bladder cancer every year, according to the National Cancer Institute. The bladder is the organ in the lower abdomen that stores urine. If cancer is found only in the cells of the lining of the bladder, it is referred to as superficial bladder cancer. However, if it grows through the lining and into the muscular wall of the bladder, it is invasive cancer. Cancer is staged by the extent of the disease, and late stages of cancer include Stages III and IV.

Risk Factors and Symptoms

• There are no known definitive causes of bladder cancer, but there are risk factors that are seen in many people with the disease. Smoking cigarettes, being over 40-years-old, being a man, and having a personal or family history of the disease are all risk factors for developing bladder cancer.

  Symptoms of bladder cancer can include blood in the urine, pain with urination, frequent urination frequently, or feeling the need to urinate without being able to urinate. Having these symptoms does not necessarily mean you have bladder cancer, so if you experience any of these, it is best to see your doctor for an examination.

Staging

• There are four stages of bladder cancer, with Stage 0 being superficial disease, and Stage IV being cancer that has spread to the pelvic or abdominal wall, or other parts of the body. The stage of the cancer impacts treatment and prognosis, so it is important to get an accurate staging of the disease.

  Stage 0 is carcinoma in situ, or cancer that is only found on the surface of the lining of the bladder. Stage I bladder cancer is when cancer cells are found deeper within the lining of the bladder, but have not reached the muscle of the bladder. Bladder cancer that is Stage III consists of cancer that has spread through the muscular wall of the bladder and is found in the tissue that surrounds the bladder, and it may also be in the prostate, uterus or vagina. The last stage, Stage IV, is cancer that has reached the abdominal or pelvic wall, lymph nodes or other organs in the body, which is known as metastasis.

Treatment

• Treatment for bladder cancer may include surgery, chemotherapy, radiation or biological therapy. For advanced bladder cancer, the most common surgery is a radical cystectomy. This surgery entails the removal of the bladder, nearby lymph nodes and part of the urethra. In men, the prostate, seminal vesicles and part of the vas deferens are also removed, and in women, the uterus, ovaries, fallopian tubes and part of the vagina are removed. A route for urine to leave the body is constructed by the surgeon.

  In patients with advanced bladder cancer who are not candidates for radical surgery, radiation is an alternative treatment that may be used. Radiation therapy pre-surgery does not improve outcomes in patients with late stage bladder cancer; rather, it increases toxicity to the gastrointestinal tract.

  Chemotherapy may be given, and for advanced bladder cancer, it is done intravenously, whereas for superficial bladder cancer, it may be given as intravesical therapy. This is when chemotherapy is delivered directly to the bladder through a tube placed in the urethra. Common regimens in chemotherapy for late stage bladder cancer include CMV (cisplatin, methotrexate and vinblastine), and MVAC (methotrexate, vinblastine, doxorubicin and cisplatin). For patients with metastatic bladder cancer, MVAC is the standard treatment.
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Prognosis

• Bladder cancer that is diagnosed in the superficial stage has a survival rate of approximately 85 percent. Metastatic bladder cancer has a poor prognosis, with roughly f5 percent of patients alive two years after diagnosis. These are general statistics, and individual prognoses depend on the stage of the cancer, characteristics of the cancer cells and response to treatment.

Living With Bladder Cancer

• Having late stage bladder cancer may mean management of the disease is more likely than "cure." A dietitian or your doctor can recommend foods to eat to keep your strength up, since many people living with cancer need enough calories to keep up their weight and protein for strength, especially during active treatment. If you have a stoma following bladder surgery, rehabilitation therapists or enterostromal therapists can help you adjust and show you how to take care of it. Living with any serious disease can be very stressful and emotional, so it is important to take care of your emotional needs, as well. Support groups, therapists, hospital social workers and other people who have survived bladder cancer can all be valuable resources to help you on your journey.