How can I manage my mother's metastatic urothelial cancer?

Question

Hi doctor,

My 58-year-old mother has metastatic urothelial carcinoma. She is postmenopausal and has mild urinary incontinence, which has worsened during treatment. We are unsure if this is due to the cancer or chemotherapy. She is also struggling with body image and intimacy concerns.

How can we help her manage symptoms while preserving dignity and emotional well-being? Are there supportive treatments for bladder symptoms and resources for intimacy or counseling?

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

The management of urothelial carcinoma, or bladder cancer, depends on the stage and grade of the tumor, as well as the patient's overall health. Treatment options include surgery, chemotherapy, immunotherapy, and radiation therapy.

For non-muscle-invasive bladder cancer, transurethral resection of the bladder tumor (TURBT) with potential intravesical therapy is common. For muscle-invasive bladder cancer, surgery (cystectomy) or radiation therapy may be used in conjunction with chemotherapy.

For your mother's condition, the treatment will depend on her overall health and the severity of the bladder cancer. The following are some of the common treatment options for bladder cancer:

Non-muscle-invasive bladder cancer (NMIBC):

TURBT: Transurethral resection of the bladder tumor is the initial treatment for NMIBC, removing the tumor.
Intravesical therapy: After TURBT, patients may receive intravesical therapy with drugs like BCG (Bacillus Calmette-Guerin) or chemotherapy (Mitomycin or Gemcitabine) to reduce the risk of recurrence.
Maintenance therapy: BCG maintenance therapy (repeated courses of BCG) may be recommended to further reduce the risk of recurrence in high-risk patients.

Muscle-invasive bladder cancer (MIBC):

Cystectomy: Surgical removal of the bladder is the primary treatment for MIBC, often combined with regional lymph node dissection.
Neoadjuvant chemotherapy: Chemotherapy given before surgery (neoadjuvant) can shrink the tumor and potentially make surgery easier.
Radiation therapy: Radiation therapy may be used after surgery to kill any remaining cancer cells or in conjunction with chemotherapy.
Adjuvant chemotherapy: Chemotherapy given after surgery (adjuvant) can help to reduce the risk of recurrence.

Metastatic bladder cancer:

Cisplatin-based chemotherapy: Platinum-based chemotherapy (Cisplatin, Gemcitabine) is a first-line treatment option for metastatic bladder cancer.
Immunotherapy: Immunotherapy, such as checkpoint inhibitors (e.g., Pembrolizumab, Atezolizumab), can be used in metastatic disease, especially in patients who have progressed on platinum-based chemotherapy or are ineligible for it.

I hope this helps. Please follow up if you have any questions or concerns.

Thank you.