Advanced bladder cancer treatment

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 will depend 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 spiritualneeds. 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.

Cancer can cause physical and emotional strain, so it’s important to look after your wellbeing. Cancer Council has free booklets and programs to help you during and after treatment. Call 13 11 20 to find out more, or visit your local Cancer Council website.

Eating well – Healthy food can help you cope with treatment and side effects. A dietitian can explain how to manage any special dietary needs or eating problems and choose the best foods for your situation.

Staying active – Physical activity can reduce tiredness, improve circulation and lift mood. The right exercise for you depends on what you are used to, how you feel, and your doctor’s advice.

Complementary therapies – Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as massage, relaxation and acupuncture may increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Work and money – Cancer can change your financial situation, especially if you have extra medical expenses or need to stop working. Getting professional financial advice and talking to your employer can give you peace of mind. You can also check whether any financial assistance is available to you by asking a social worker at your hospital or treatment centre or calling Cancer Council 13 11 20.

Relationships – Having cancer can affect your relationships with family, friends and colleagues in different ways. Cancer is stressful, tiring and upsetting, and this may strain relationships. The experience of cancer may also result in positive changes to your values, priorities or outlook on life. Give yourself time to adjust to what’s happening, and do the same for those around you. It may help to discuss your feelings with each other.

Sex life – Cancer can affect your sex life in physical and emotional ways. The impact of these changes depends on many factors, such as treatment and side effects, your self confidence, and if you have a partner. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

Contraception and fertility – If you can have sex, you may need to use certain types of contraception to protect your partner or avoid pregnancy for a time. Your doctor will explain what precautions to take. They will also tell you if treatment will affect your fertility permanently or temporarily. If having children is important to you, discuss the options with your doctor before starting treatment.