What Is Stage 4 Bladder Cancer?

Stage 4 bladder cancer is a bladder cancer that has spread through the bladder wall. In this stage, cancer has also invaded the lymph nodes, abdominal wall, and other body organs. This type of cancer is also known as "metastatic" bladder cancer.

Stage 4 bladder cancer applies to bladder cancer that has:

• Grown and spread through the wall of the bladder, to the abdominal wall, and pelvis. However, at this stage, it has not invaded the distant lymph nodes and organs (N0, M0, and T4b).
• Spread and grown to the neighboring lymph nodes but not the distant lymph nodes (T, N1, N3, and M0).
• Spread to distant body organs such as the lungs, bones, and liver.

Signs and Symptoms of Stage 4 Bladder Cancer

The signs and symptoms of this stage of bladder cancer include:

• the presence of blood and blood clots in the urine
• frequent urination
• back pain on one side of your lower abdomen
• burning sensation or pain during urination
• urination mostly at night
• difficulty during urination

The above symptoms can be used to diagnose a stage 4 bladder cancer, but sometimes, they can be contradicting because they resemble those of other stages.

Stage 4 bladder cancer is also said to be metastatic since it has the capability of spreading from the bladder to the other body parts. People with metastatic stage 4 cancer can experience the symptoms depending on where cancer has spread. If the stage 4 bladder cancer spreads to the lungs, you are likely to experience symptoms such as coughing and chest pain.

Treatment for Stage 4 Bladder Cancer

Chemotherapy

Chemotherapy is one of the best treatment options for stage 4 bladder cancer. Before an effective chemotherapy, a medication for this stage of cancer was developed, and the survival period the patients could have after diagnosis was three to six months. You should know that this type of bladder cancer is sensitive to chemotherapy medications and respond very rapidly to them. Even though some few cases have survived for more than five years after diagnosis, chemotherapy for this stage is aimed to relieve the symptoms.

A combination of different chemotherapy medications has been mostly used to relieve the symptoms of stage 4 bladder cancer. A single chemotherapy drug cannot be sensitive to the cancerous cells, hence, it would be less effective or not effective at all. Major chemotherapy agents used to treat this stage of bladder cancer are GC and MVAC. GC is simply a combination of cisplatin and gemzar. On the other hand, MVAC is a combination of methotrexate, vinblastine, doxorubicin and cisplatin. The two medications, MVAC and GC, have been seen to have a similarity in their effectiveness but GC has a few side effects compared to MVAC.

Stage 4 Bladder Cancer Surgery

Surgery for this type of bladder cancer involves the removal of the tissue surrounding the seminal vesicles, bladder, fallopian tubes, urethra in women, ovaries, uterus in women, and the prostate in men. A regional lymph node dissection is recommended for stage 4 bladder cancer treatment aiming to control any local cancer spreading plus other complications. Surgery is actually recommended if repeated radiation therapy and chemotherapy fail to respond.

Chances of Survival with Stage 4 Bladder Cancer

When stage 4 bladder cancer becomes metastatic, it becomes difficult to treat since it has already spread to other parts of the body. The early you get diagnosed of this type of cancer, the higher the chances of its cure. After a diagnosis of stage 4 bladder cancer, you have 15% chances of surviving for five years, which means that you can proceed with your treatment for at least five years.

If stage 4 cancer has spread to the regional lymph nodes, there is a 34% chance of living for up to five years under medication.

You should know that the survival rates given here are only estimates. You might not know what will happen to a person. A small number of people lived longer than five years than the given estimates.

Better treatment options for stage 4 bladder cancer could be available soon due research and drug development. The details of this bladder cancer stage will determine the treatment and prognosis options. It is important to know the grade of the stage 4 bladder cancer as well as other details related to the condition for better treatment options plus life expectancy.

Strategies to Improve Treatments

As the treatment of stage 4 bladder cancer progresses, more improved treatments have also been discovered. The following are ways to improve the treatment of bladder cancer:

1. Supportive care: means the use of treatments aimed to reduce or control the side effects of cancer drugs. The discomforts experienced by people with stage 4 bladder cancer are caused by the treatments' side effects, so there should be an optimal therapy delivery. In order to get optimal outcomes from bladder cancer treatment and improvement of life quality, it is good to reduce and control the side effects.

2. Drug resistance inhibitors: since the bladder becomes drug resistant after and during treatment, several drug testings are done to determine if they prevent the cancer from being drug-resistant. These drugs prevent the bladder cancer from becoming multi-drug resistant.

3. Chemotherapy Regimen: the production of a new multi-drug chemotherapy treatment program is under way. It involves the use of new anti-cancer therapies that include an addition of extra drugs such as taxane, carboplatin, and gemcitabine.

4. New cancer therapies: many cancer therapies are being targeted. The new therapies have the ability to interfere with the pathways used in the growth and survivial of cancers cells. The targeted therapies are as follow:

• therapies to reduce blood supply to the bladder cancer cells
• therapies aimed to block any signals from reaching cancerous cells
• therapies that can stimulate your immune system to recognize and also attack cancerous cells

The above therapies will be combined together with other bladder cancer treatments (e.g., conventional chemotherapy). Several of these targeted therapies are under evaluation to see if they can effectively treat stage 4 bladder cancer.

5. Phase 1 trials:  some new anti-cancer therapies have been developed and analyzed in phase 1 clinical trials. The aim of the phase 1 trials is to evaluate new medications in order to get the best method of treatment administration in case the drug has any anti-cancer activities.

The Bottom Line

If you happen to be diagnosed with stage 4 bladder cancer, it would be the scariest and most overwhelming moment of your life. Stage 4 bladder cancer is one of the most advanced stages of bladder cancer carrying the worst prognosis. However, the treatment for this stage of bladder cancer can reduce or fully eliminate the signs and symptoms helping one to live longer. It is very important to consider the advantages and disadvantages of treating this cancer stage since every treatment comes with unique side effects.

Patients with stage 4 bladder cancer have cancer that has extended through the bladder wall that has invaded the pelvis and abdominal wall, has lymph node involvement, or has spread to distant sites. Stage 4 bladder cancer is also referred to as “metastatic” bladder cancer.

A variety of factors ultimately influence a patient’s decision to receive treatment for cancer. The purpose of receiving cancer treatment may be to improve the symptoms through local control of the cancer, increase a patient’s chance of remission, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.