Treating symptoms of metastatic bladder cancer

Metastatic bladder cancer means that the cancer that began in your bladder has spread to another part of the body such as the bones. It is also known as advanced bladder cancer.

The symptoms of metastatic bladder cancer

Symptoms of metastatic bladder cancer depend on where the cancer has spread to. Symptoms might include:

• problems passing urine

• bone, back or tummy pain

• tiredness or feeling unwell

• breathlessness

• weight loss and loss of appetite

• swelling

The symptoms can be difficult to cope with. But your doctors and nurses can support you and give you treatments to help relieve the symptoms.

Treatments such as chemotherapy, radiotherapy or targeted cancer drugs might shrink the cancer, reduce symptoms and help you feel better. You can also have other medicines to help relieve symptoms, such as painkillers. 

Symptoms control team or palliative care team

There are symptom control teams in most cancer units. They are also called the palliative care team. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.

Treatment for problems passing urine

You might have problems passing wee (urine). You might:

• pass urine more often

• need to get up in the night to pass urine

• have difficulty passing urine

• suddenly not be able to pass urine (acute urine retention)

• have a strong urge to empty your bladder

• have blood in your urine

• have kidney problems

• leak urine (incontinence)

Call your doctor or go to the nearest accident and emergency department if you suddenly can’t pass urine

Treatments depend on the cause of the problem. You might: 

• have a tube into your bladder (catheter) to drain the urine
• have radiotherapy to make the cancer smaller and help if there is a blockage
• have surgery (Trans urethral resection of bladder tumour, or TURBT) to remove cancer from your bladder

The cancer might block the tubes that drain urine from your kidney to your bladder (the ureters). To allow urine to flow, the doctor might might put a tube into your kidney. This is called a nephrostomy tube and means your wee drains into a bag outside your body. Or they might put a small tube into the ureter to keep it open. This tube is called a stent. 

Managing blood in your urine (haematuria)

You might have blood in your urine. Bleeding can be caused by the cancer itself. Or it might be a side effect of radiotherapy. Infection can also make this symptom worse.

It can be painful if there are blood clots. These are painful to pass and can cause blockages, making it hard to wee. It can also be alarming to see blood in your wee. Your doctor will give you pain killers if you are in pain.

To help with bleeding, your doctor might suggest you have:

• surgery to remove cancers from your bladder (transurethral resection of bladder tumour - TURBT)

• cystoscopy and bladder washouts

• a drug called tranexamic acid that can help to stop bleeding

• radiotherapy

• a treatment called embolisation which blocks the blood supply to the bleeding bladder tissue

You might need to spend time in hospital if you are bleeding heavily. You usually have a tube into your bladder (catheter) to help you pass urine.

You are likely to have blood clots in your urine. This can block the catheter. To help with this, the nurse will pass fluid into your bladder. They drain it out through the catheter. This is called bladder irrigation. 

Treatment for bone problems

You might have bone pain if your cancer has spread to your bones. Your bones might be weaker, this means that they could break more easily.

Possible treatments include:

• radiotherapy
• drugs to help strengthen your bones (bisphosphonates or a drug called denosumab)
• painkillers

Treating pressure on the spinal cord

Cancer that has spread into the spinal bones can cause pressure on the spinal cord. This is called spinal cord compression. The pressure on the spinal cord stops the nerves from working normally. This can cause:

• back pain
• changes in sensation, such as tingling or numbness
• changes in the way your bowel or bladder work
• difficulty walking

Spinal cord compression is an emergency. It is important to get treatment as soon as possible.

Treatment for tiredness and feeling unwell

Tiredness is a common symptom of advanced cancer. You may feel that you don’t have any energy and this can be overwhelming. 

Let your doctor or nurse know if you’re very tired as they might be able to prescribe medicine to help or other treatments. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).  Or you might have iron through a drip to help your body make more red blood cells.

Resting

It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help. 

Exercise

Exercising can be hard when you feel very tired. But research shows that daily light to moderate exercise can give you more energy. Going for a gentle walk is very good. Gentle exercises in bed or standing up can help if you can’t move around easily. 

Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.  

Sleeping

You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.

Treatment for breathlessness

You might feel breathless if your cancer has spread to your lungs or if you have a low number of red blood cell levels (anaemia). You can learn breathing techniques that can help. You might need a blood transfusion to give you red blood cells if you have anaemia.

Tell your doctor or nurse if you feel breathless. They can prescribe medicines to make your breathing easier.

Treatment for loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can to minimise how much weight you lose.

Tips

• Eating several small meals and snacks throughout the day can be easier to manage.

• Ask your doctor to recommend high calorie drinks to sip between treatments if you are worried about losing weight.

• Eat whatever you feel like eating rather than what you think you should eat.

• Make up calories between treatments for the days when you really don’t feel like eating.

• Drink plenty of fluids even if you can't eat.

• Don't fill your stomach with a large amount of liquid before eating.

• Try to eat high calorie foods to keep your weight up.

Talk to your dietitian about having high calorie drinks to boost your calorie intake if you need them.

Treatment for swelling (lymphoedema)

You might have swelling called lymphoedema if the cancer has spread to the lymph glands in the groin or pelvis. The swelling might be in:

• one or both legs
• the lower part of the tummy (abdomen)
• the genital area

Reduce your risk of getting skin infections by looking after your skin. For example, clean and dry any scratches, burns or cuts and use antiseptic cream and a plaster. This is because a skin infection can increase the risk of swelling.

Lymphoedema can be difficult to cope with. Lymphoedema practitioners can offer treatment and support. Speak to your doctor or nurse if you notice any swelling.

Looking after your mental health

You might find it difficult to cope when you are diagnosed with metastatic or advanced cancer.

It is common for people with metastatic bladder cancer to feel sad or become depressed. You may find it helpful to understand this as a part of your illness. Talk to your specialist nurse about how you are feeling. They can arrange for more support if you need it.