Metastatic Bladder Cancer
Metastatic urothelial cancer is a systemic disease whose first fork is cisplatin eligibility — platinum-based chemotherapy where possible, with immunotherapy and other systemic options, and palliation woven throughout.
The big picture
Once disease is metastatic, treatment is systemic. The pivotal question is cisplatin eligibility (renal function, performance status, hearing, neuropathy, cardiac status). Eligible patients receive platinum-based combination chemotherapy; ineligible patients and those progressing receive immunotherapy and other systemic agents, with palliative care alongside.
First decide cisplatin eligibility; platinum-based chemotherapy leads when possible, with immunotherapy and palliation as key parts of the pathway.
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Systemic therapy chosen by cisplatin eligibility and prior treatment, integrated with palliative care for symptoms.
Procedure chooser
- Highly selected metastasectomy/consolidation in exceptional cases
Follow-up
- Response and toxicity on imaging/clinical review
- Symptom control
- Renal function
- Per treatment protocol
- Disease response/stability with controlled symptoms
- Progression or intolerable toxicity
- Response assessment and new symptoms
- Treatment toxicity
- Progressive disease and end-of-life planning
Memory hooks
Metastatic = systemic therapy.
First ask: cisplatin eligible?
Platinum leads; immunotherapy follows.
Palliate in parallel.
Board traps
Giving cisplatin to a patient with poor renal function/performance status — assess eligibility first.
Forgetting obstruction can cause the renal failure that then blocks chemotherapy.
Treating systemically while ignoring uncontrolled symptoms.
Clinical cases
A 70-year-old with metastatic urothelial cancer has an eGFR of 35, a performance status of 2, and pre-existing neuropathy.
How does this affect first-line systemic therapy?