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Bladder Cancer Awareness Month: Advanced Bladder Cancer

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Published on May 10, 2021

What Is Advanced Bladder Cancer?

May is Bladder Cancer Awareness Month! Keep watching to hear Dr. Stephen Riggs, MD, Associate Professor in the Division of Urology at Levine Cancer Institute, explain advanced bladder cancer and the difference between locally advanced or metastatic bladder cancer. Dr. Riggs also discusses the fast-moving nature of advanced bladder cancer, why it is important to see a specialist, and the treatments that are in development to help improve the quality of life for patients.

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Transcript | Bladder Cancer Awareness Month: Advanced Bladder Cancer

What Is an Advanced Bladder Cancer Diagnosis? Do I Need a Second Opinion?

Dr. Riggs: When people say to me advanced, I usually think of that in two ways. Are you locally advanced, are you advanced – I mean, advanced is a general term in cancer. So, what does that mean? I think a lot of people talk about advanced, they mean metastatic, they mean stage four. So, let's just focus on that for a second. So yeah, bladder cancer when it's doing that, when it's in the sphere of “I'm more advanced, I'm high grade, I'm stage four.” That is articulating, suggesting, to that individual that you have a rapidly moving cancer. It doesn't get outside the bladder or the organ it started in unless it's usually moving with some pace to it. That doesn't mean you need to see the doctor tomorrow, but I would say with a general sense, like within one to two weeks, you'd probably want to be engaged with providers that understand bladder cancer.

And then when you talk about second opinion, I think the easy answer is always to say, “Yes, get a second opinion.” I'm also cognizant that not everybody has the resources to do that immediately, but I think in the virtual world, in the emerging technology that's come in the last year, that you can do virtual visits. You can engage with other providers. And I think the best advice I give to people, number one, seek a second opinion if possible. Number two, ask your doctor, the person they're seeing about a second opinion, “Hey, is this your area of specialty?” Like, “Hey, bladder cancer is not as ubiquitous. It's not as common as lung cancer. It's not as common as breast cancer.”

I will tell you most people are not going to be experts in bladder cancer. They may treat it, but bladder cancer tends to be local to more academic institutions, just in the volume. So, you may want to… I think an easy answer is always to say yes, but most importantly, ask questions, right? Ask logical questions to your treating provider. And then I think frame that back to that provider about, “Hey, if you were going to get a second opinion, where would you go? Can you help me facilitate that?” and work within your resources.”

And then when you talk about metastatic bladder cancer, I think really any bladder cancer right now, and really any solid cancer, the emerging landscape in the treatment of cancer is so fast right now that the reason for the second opinions and the reason to think through it in different avenues is that your options that were there last year may be fundamentally different than they are this year. And when you talk about metastatic bladder cancer and you talk a lot of systemic options, chemotherapy, immunotherapy, targeted therapy. Those platforms are emerging and evolving rapidly. And so, you definitely want some understanding of what your options are.

Can Advanced Bladder Cancer Be Cured?

Bladder cancer tends to come back in general. Now that doesn't mean you won't be cured. You just may be dealing with it as a disease over a long period of time. Now disease, when it's outside the bladder, is really hard to cure. So metastatic disease is really hard to cure. That doesn't mean it won't be cured, but it's pretty hard to cure. And that's where a lot of the most recent research is coming in in that space.

We are definitely moving forward in the area, especially in the last couple of years, in terms of immunotherapy, is one to highlight. And looking at specific targets of drugs that are coming out that are unique to bladder cancer, or unique across several cancers in extending the life expectancy for people. So, I usually tell people when you have metastatic bladder cancer, we're hoping to really extend your life, it is unlikely to be cured.

A lot of my passion for bladder cancer and working with patients comes from my, honestly, my family history. My father and grandfather died of bladder cancer. It's very real to me. I've walked the other side of the fence, so I've been a caregiver. And so, I don't want to articulate that I get it, but I also am very empathetic to that side. And I think the reality, the deeper you get into any disease state and in particular, just discussing bladder cancer, you realize that it's really important to understand the staging in bladder cancer. It's really important as a patient to have a few weapons in the bag, to engage with the provider. And I think just those simple open-ended questions—“What's next? Is this right? Should I get a second opinion? If so, where should I get a second opinion?”—you know, are really thoughtful because you want to be an engaged participant in any disease and bladder cancer is no different.

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