does bladder cancer metastasis to brain



Bladder cancer is known to metastasize to multiple sites of the body but rarely to the brain. When it does metastasize to the brain the prognosis is poor with median survival of 2-4 months despite treatment [8,9].Sep 10, 2019

Does bladder cancer cause central nervous system metastases?

Results: Brain metastases from bladder carcinoma were commonly accompanied by uncontrolled systemic metastases. Multiple brain lesions developed in 14 of the 16 patients. Of the 16 patients 14 received radiation therapy with or without surgery, 1 was treated surgically and 1 did not receive any treatment.

What is the prognosis of brain metastasis in bladder cancer?

 · INCIDENCE OF BLADDER CANCER BRAIN METASTASES. Incidence of BC brain metastases in the pre-cisplatin era was low, ranging from <1% to 7% based on autopsy series and radiotherapy trials on treatment of brain metastases, with most series closer to 1–3% . Clinical series in the pre-cisplatin era likely underestimated the incidence of BC brain metastases due …

What is distant bladder cancer metastasis?

Brain metastases have an ominous prognosis in patients with bladder cancer primaries. Considering the sum of the retrospective and prospective reports, we recommend that patients with solitary brain lesions and good performance status be aggressively managed with surgical resection and postoperative radiation therapy.

Can metastatic cancer spread to the brain?

 · Brain metastases from bladder carcinoma were commonly accompanied by uncontrolled systemic metastases. Multiple brain lesions developed in 14 of the 16 patients. Of the 16 patients 14 received radiation therapy with or without surgery, 1 was treated surgically and 1 did not receive any treatment.


Where does bladder cancer usually metastasize to?

Not all bladder cancers will spread. But If it does it’s most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagina, or into the pelvis.

Which cancers are most likely to metastasize to the brain?

The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin (melanoma), colon, kidney and thyroid gland. Metastatic brain tumors are five times more common than primary brain tumors (those that originate in the brain).

Is bladder cancer likely to metastasize?

As many as 50% of patients with muscle-invasive bladder cancer may have occult metastases that become clinically apparent within 5 years of initial diagnosis and around 5% will have distant metastasis at the time of initial diagnosis. Most patients with overt metastatic disease die within 2 years despite chemotherapy.

What signs would indicate metastasis to the brain?

Signs and symptoms of brain metastases include: Headache, sometimes with vomiting or nausea. Mental changes, such as increasing memory problems. Seizures.

What were your first signs of a brain tumor?

Brain Tumor: Symptoms and SignsHeadaches, which may be severe and worsen with activity or in the early morning.Seizures. People may experience different types of seizures. Certain drugs can help prevent or control them. … Personality or memory changes.Nausea or vomiting.Fatigue.Drowsiness.Sleep problems.Memory problems.More items…

How long do you live with brain metastases?

A decade and a half ago, people diagnosed with a brain metastasis survived, on average, less than 6 months. Treatments have improved in the intervening years, and today, people with brain metastases are living longer than ever before.

What are the signs that bladder cancer has spread?

The signs and symptoms of bladder cancer that has spread to other parts of the body include:tiredness or weakness.pain when urinating.difficulty urinating or inability to urinate.pain in the lower back on one side of the body.weight loss.swollen feet.bone pain.

What are the symptoms of end stage bladder cancer?

Symptoms of Advanced Bladder CancerAn inability to urinate.Lower back pain on one side of the body.Loss of appetite.Unintended weight loss.Overwhelming fatigue.Bone pain.Swelling in the feet.

What are the symptoms of metastatic bladder cancer?

Symptoms of metastatic bladder cancerBlood in the urine.Frequent urination.Pain or burning during urination.Need to urinate despite an empty bladder.Being unable to urinate.Lower back and abdominal pain.Swelling in the feet.Fatigue and weakness.More items…•

How fast does brain metastases grow?

This study demonstrated the mean interval from primary lung cancer diagnosis to brain metastasis was 1.17 years and 4.64 years in the breast cancer group. This is slightly longer than the average time of diagnosis of breast cancer to brain metastasis previously reported of 34 months (2.83 years).

What does brain Mets headache feel like?

Every patient’s pain experience is unique, but headaches associated with brain tumors tend to be constant and are worse at night or in the early morning. They are often described as dull, “pressure-type” headaches, though some patients also experience sharp or “stabbing” pain.

Can you have a brain tumor for years without knowing?

Some people with a brain or central nervous system tumor have no symptoms. In some cases, doctors discover a tumor during treatment for another issue. As a brain tumor grows and presses on surrounding nerves or blood vessels, it may cause symptoms.


How many bladder cancer patients have metastases?

Nearly 50% of bladder cancer patients either present with metastatic disease or relapse distantly following initial local therapy. Prior to platinum-based chemotherapy, the incidence of bladder cancer central nervous system metastases was approximately 1%; however, their incidence has increased to 3–16% following definitive treatment as platinum-based regimens have changed the natural history of the disease. Bladder cancer brain metastases are generally managed similarly to those from more common malignancies such as non-small cell lung cancer, with surgery +/–adjuvant radiotherapy, or radiotherapy alone using stereotactic radiosurgery or whole brain radiotherapy. Limited data suggest that patients with inoperable urothelial carcinoma brain metastases who are not candidates for stereotactic radiosurgery may benefit from shorter whole brain radiation therapy courses compared to other histologies, but data is hypothesis-generating. Given improvements in the efficacy of systemic therapy and supportive care strategies for metastatic urothelial carcinoma translating in improved survival, the incidence of intracranial failures may increase. Immune checkpoint blockade therapy may benefit cisplatin-ineligible metastatic urothelial carcinoma patients as first-line therapy; however, the effectiveness of immune checkpoint blockade to treat central nervous system disease has not been established. In this review, we discuss the incidence and management of bladder cancer brain metastases and considerations regarding variations in management relative to more commonly encountered non-urothelial histologies.

What is the treatment for brain metastases?

For patients with a limited number of brain metastases that are amenable to resection, standard treatment for most solid malignancy histologies is surgery followed by either adjuvant stereotactic radiosurgery (SRS) to the surgical cavity or WBRT.

Is ICB effective against brain metastases?

ICB therapy has promise for treatment of BC brain metastases. While the CNS has classically been regarded as an immune privileged organ, resistant to penetration by mAbs and effector T cells due to the blood-brain barrier, pre-clinical and clinical data suggests a role for this therapy [ 18, 19, 51, 52 ]. Pre-clinical data indicates ICB efficacy against CNS lesions is CD8 + dependent, greater for combined programmed cell death protein-1 (PD-1)/cytotoxic T lymphocyte antigen-4 (CTLA-4) ICB versus monotherapy, enhanced when extracranial disease is present, and facilitated by antigen priming in draining cervical lymph nodes [ 53 ]. Perhaps the strongest clinical data comes from the melanoma experience where dual ICB targeting PD-1 and CTLA-4 was associated with a 40–60% response rate in brain metastases [ 54–57 ]. Additional compelling data from patients with NSCLC indicates that 25–30% of patients with active brain metastases from NSCLC exhibited objective clinical responses to ICB with nivolumab, and that patients with active brain metastases did not have worse OS compared to those without brain metastases suggesting that patients with brain metastases should be considered in future clinical trials [ 58 ].

Who wrote the critical review of the role of definitive radiation therapy in bladder cancer?

Gospodarowicz MK , Warde PR . A critical review of the role of definitive radiation therapy in bladder cancer. Semin Urol. 1993;11:214–26.

Can MRI be used for brain metastases?

Brain metastases from BC have increased over the past 40 years in parallel with improvements in systemic therapy; however optimal management remains uncertain. Due to the relative rarity of intracranial involvement, brain MRI is not recommended during initial workup, though suspicion should be higher for patients following recurrence and with new neurological symptoms. Our review of the literature does not suggest that routine MRIs should be part of surveillance imaging for patients with metastatic disease and no prior history of intracranial involvement Systemic therapy is typically employed for advanced or recurrent BC, but the efficacy of chemotherapy or ICB against BC brain metastases remains unclear. Local therapy remains the treatment of choice for BC brain metastases. The available data suggests that it is reasonable to treat BC brain metastases in a similar fashion to how brain metastases are treated for other more common solid malignancies. For patients with limited intracranial disease and good performance status, maximal safe resection when feasible followed by adjuvant stereotactic radiosurgery is generally preferred, although adjuvant WBRT is an option as well. Stereotactic radiosurgery alone can be considered for patients with a limited burden of intracranial disease, especially if lesions are not accessible or too numerous for surgery. For patients with more extensive intracranial disease, WBRT is a reasonable option. Patients with UC brain metastases treated with WBRT may derive benefits in preserving neurocognition with memantine and hippocampal avoidance WBRT if survival ≥4 months is predicted. SCCB brain metastases are commonly treated with chemotherapy and WBRT rather than SRS, though recent suggests that SRS may not be an inferior choice for select patients. ICB mAbs may represent a new option for preventing BC intracranial failures or treating known BC brain metastases, but more rigorous study is needed. Prognostic scoring systems may assist in determining aggressiveness of management for BC patients with intracranial failure.

How long do bladder cancer patients live after brain metastasis?

Rosenstein et al studied 19 patients with bladder cancer and noted a median survival of 4 months after the brain metastasis diagnosis. 9 Of their 19 patients 13 with a single brain lesion survived a mean of 14 months after the secondary diagnosis.

What is brain metastasis?

Brain metastases represent a serious and debilitating complication in patients with cancer. Some studies suggest that the incidence of central nervous system metastases is higher in patients who receive aggressive initial treatment for bladder carcinoma. 6, 7 In a new 1 and an old 8 study 16% of patients treated with MVAC had brain metastases. In the new study the time from initial diagnosis to the diagnosis of brain metastasis was 7 to 38 months 1 and in the old study it was 6 to 42 months. 8

How old is a patient with brain metastasis?

Table 2 lists patient and tumor characteristics at the time of the brain metastasis diagnosis. Median age was 70.5 years (range 39 to 79). In all 16 patients neurological symptoms led to the diagnosis of brain metastasis. Headache and motor weakness were the most common symptoms. The median interval between the diagnosis of bladder carcinoma and brain metastasis was 8 months (range 0 to 69).

Does whole brain radiation have local control?

In our series whole brain radiation therapy was not followed by durable local control of brain metastases since only 1 of 4 patients who received whole brain radiation therapy alone had local control on followup scans, and it was associated with morbidity. However, the patient who received stereotactic radiosurgery had controlled brain metastases on followup scans. All 16 patients were started on steroid therapy at the time of brain metastases diagnosis but it was successfully withdrawn in only 3. The results of randomized trials of the concurrent administration of temozolomide and radiation therapy followed by adjuvant temozolomide therapy compared with radiation alone are promising. They suggest that chemotherapy may have a role in treating patients with newly diagnosed brain metastases. 18

Is brain cancer rare?

Before the advent of active cisplatin based chemotherapy, brain metastases from bladder cancer were rare . In a 1977 report Whitmore et al noted brain metastases in only 5 of 451 patients (1%) who underwent treatment for bladder cancer between 1947 and 1971. 1 Others drew similar conclusions. 2 In a 1992 report Anderson et al observed that 9 of 293 patients (3%) with transitional cell carcinoma of the bladder who presented between 1977 and 1987 had brain metastases. 3

Is radiation therapy effective for bladder cancer?

Although the number of patients in this study was small, results indicate that radiation therapy alone is inadequate treatment. Therefore, when possible, we advocate more effective treatment by combi ning radiation therapy with other treatment modalities, as recommended in ongoing clinical trials.

Is brain metastasis poor?

Survival after brain metastases in patients with bladder carcinoma is poor. Whole brain radiation therapy alone seems to be inadequate treatment and better treatment regimens are required. Ongoing clinical trials are evaluating improved techniques of radiation therapy, radiosensitizers and chemotherapy. Enrollment into prospective clinical trials, especially randomized trials, is encouraged to determine the optimal treatment for brain metastases.

Where does urothelial carcinoma spread?

The first step in the metastasis of urothelial carcinoma of the bladder is local lymphatic spread into the obturator, superior gluteal, inferior gluteal, external iliac, and common iliac nodes. Then, tumor cells disseminate through the para-aortic lymphatic chain to the thoracic duct and enter the general circulation. When the local nodes become obstructed, lymphohematogenous spread occurs by tumor cells shunted into the vascular compartment. Hematogenous metastases spread either via the pelvic plexus into the inferior vena cava and general circulation or via the perivertebral vein into the azygos, hemiazygos, intercostals, and other systemic veins [6].

Is bladder cancer a malignancy?

Bladder cancer is the second most common malignancy of the genitourinary tract in Korea. Bladder cancer has variable metastatic potential and almost any organ can be involved by metastasis. Lymph nodes, liver, lung, and bone are the most common metastatic sites of urothelial carcinoma of the bladder, with skin, brain, heart, and kidney being rare sites of metastasis [1-3]. We report a case of urothelial carcinoma of the bladder with brain and abdominal skin metastasis.

Is bladder cancer a metastatic disease?

Skin and brain metastases from urothelial carcinoma of the bladder are relatively rare [3]. According to the Brain Tumor Registry of Japan, only 0.6% of metastatic brain tumors were from bladder cancers [8]. In another study, central nervous system metastases were found in fewer than 1% of cases [1]. Urothelial carcinoma metastasizes to the brain hematogenously, and cancer cells are filtered by the lungs. Therefore, brain metastasis may be secondary to pulmonary metastasis. Many patients with brain metastases die before the brain lesion becomes manifest. Mueller et al. [9] found that among 10,417 cases of cutaneous metastases, only 1.1% represented a primary urologic lesion. Like brain metastasis, Spector et al. [10] suggested that skin metastasis in urothelial carcinoma of the bladder is a result of increased longevity in successfully treated patients. There are four mechanisms of metastatic dissemination by which the skin may be involved: 1) direct invasion from an underlying neoplasm, 2) iatrogenic implantation from an operation, 3) lymphatic spread, or 4) hematogenous spread [2,9]. In this case, similar to a patient reported by Ku et al. [8], skin metastasis was likely by hematogenous spread rather than other mechanisms. However, brain and skin metastasis is regarded as a late manifestation of systemic spread. The mean survival period of most patients with bladder cancer is relatively too short for manifestations of brain or skin metastatic lesions to develop. Thus, our case suggests that brain or skin may be rare sites for metastatic lesions.

Does the neurologist feel that he has had a stroke?

The neurologist doesn’t feel that he has had a stroke as the symptoms don’t seem to match up. He was almost 100% back to normal yesterday, then today he relapsed and was confused again and refused to eat.

Does bladder cancer go to the brain?

My husband had traditional cell bladder cancer, all for clear for two years, went thru thru the chemo, had bladder removed, had pet/ct scan no evidence of cancer December of 2014 , then started leaning leaning to the left on January 1st 2015 , headaches, leg problem, got MRI and had a tumor quite large in his left cerebellum (brain) it was the same cell, transitional as the bladder, so yes bladder cancer does go to the brain.

How does bladder cancer spread?

Bladder cancer spreads when cancerous cells reproduce and invade surrounding healthy tissues. This is known as metastasis. Usually, metastatic bladder cancer refers to cancer that has spread to distant organs, but metastasis can occur locally in the muscles and connective tissues that are directly adjacent to the bladder as well.

What is the treatment for bladder cancer?

Potential treatment options may include chemotherapy, radiation therapy and clinical trials.

Can bladder cancer be metastasized to lymphatic system?

Once cancerous cells have reached the lymphatic system, they can make their way to almost any part of the body. However, the most common sites for distant bladder cancer metastases include the:

Can bladder cancer spread to other organs?

Metastatic bladder cancer can also spread to other organs in the urinary and reproductive tracts, such as the prostate, uterus and vagina.

Does Moffitt Cancer Center treat bladder cancer?

At Moffitt Cancer Center, we’ve treated many patients with metastatic bladder cancer, creating ta ilored treatment plans for every single one. To help ease the burdens of treatment, we also offer comprehensive supportive care services for patients and their caregivers.

Where Bladder Cancer Can Spread

The bladder is a hollow organ that holds urine. It has flexible walls that are composed of several layers. When bladder cancer starts to spread, it grows through each layer of the bladder wall.

Symptoms and Complications

The first symptom of bladder cancer is usually blood in the urine. However, it’s possible to have blood in your urine and not see it. Laboratory testing can identify blood in urine, even when it’s not visible to the eye. As bladder cancer spreads, you may experience other symptoms, too. Advanced bladder cancer symptoms include: 5

Treatment Options

Treatments for metastatic bladder cancer can vary, based on things like how extensively your cancer has spread, your overall health and strength, and your current symptoms.

Living With Bladder Cancer

Bladder cancer symptoms and treatments can be overwhelming. No matter where you are on your treatment journey, you’ll need to meet with your healthcare provider for regular checkups and tests. Talking to your healthcare team about the next steps and what to expect can provide a road map during this time.


Metastatic bladder cancer is a challenging diagnosis. Your health, strength, and age will all play a role in your prognosis. How well your cancer responds to treatment is also a significant factor.


Metastatic bladder cancer is cancer that has spread outside of the bladder to other parts of the body. If you have metastatic bladder cancer, your treatment will be focused on destroying or slowing down cancer cells throughout your body, not just in your bladder.

A Word From Verywell

A diagnosis of metastatic bladder cancer can feel overwhelming, but there’s treatment to help manage symptoms and slow disease progression. No matter where you are on your treatment journey, it’s important to maintain regular appointments with your healthcare provider to keep your cancer under control.

What are the symptoms of brain metastases?

Brain metastases cause many of the same symptoms as tumors that originate in the brain, such as: Seizures. Numbness. Balance and coordination issues. Headaches that are sometimes accompanied by nausea or vomiting. Dizziness. Cognitive impairment, including confusion, memory loss and personality changes.

What is metastatic cancer?

Pinterest. Email. If you or a loved one have been diagnosed with cancer, you’ve probably heard the term “metastasis.”. This refers to when cancer develops in one part of the body and then spreads to another part of the body (for example, when breast cancer spreads to the brain). This generally happens when cancer cells detach from …

What is the term for cancer that spreads to the brain?

When cancer spreads from a different part of the body to the brain, the metastatic tumors are referred to as “brain metastases.”. The brain is a relatively common location for metastasis to occur. In fact, one in four cancer patients experience brain metastasis.

What happens when cancer cells detach from the main tumor?

This generally happens when cancer cells detach from the main tumor (the “primary tumor”), travel through the bloodstream or lymphatic system and then settle in another part of the body and begin growing there , as well (known as “metastatic tumors”).

Where do brain tumors come from?

Although any type of cancer can spread to the brain, brain metastases most often originate from cancer in the lungs, breasts, kidneys or colon.

Can you treat brain metastases?

Fortunately, brain metastases often respond favorably to treatment, especially if they’re diagnosed at an early stage. For diagnosis and treatment of brain metastases, you can feel confident turning to Moffitt Cancer Center .

Leave a Comment