According to the National Institutes of Health (NIH), bladder cancer that has spread to the liver is in stage IV, metastatic disease, or the final stage. The cancer is deemed incurable, and treatment is largely palliative, aimed at improving quality of life, easing pain and discomfort rather than achieving any definite cure.
There are several treatment options available to achieve this.
Chemotherapy
Cancer of the bladder with metastasis to the liver requires treatment that goes throughout the whole body. According to the American Cancer Society (ACS), the treatment of choice is systemic chemotherapy, involving the use of pills or intravenous injections to deliver drugs to the bladder and liver at the same time through the systemic circulation. These drugs used in chemotherapy kill the cancer cells or stop them from growing. Chemotherapy is used alone or as an adjunct to surgery and radiation therapy. The NIH advises that a combination of two or more drugs is preferred in the systematic chemotherapy of metastatic bladder cancer. Examples of such effective combinations are gemcitabine and cisplatin, paclitaxel and carboplatin, and the older M-VAC combination made up of methotrexate, vinblastine, doxorubicin, or Adriamycin and cisplatin. Other drugs listed by the NIH for the treatment of this cancer are ifosfamide, cyclophosphamide and docetaxel.
Surgery
Surgery aimed at improving quality of life and reducing discomfort, rather than achieving a cure, is called palliative surgery and this, according to the ACS, is the aim in stage IV bladder cancer. The surgery usually done depends on the size of the cancer mass and its effects. Options include radical cystectomy which, according to the Mayo Clinic, involves the removal of the entire bladder and surrounding lymph nodes. In men, radical cystectomy also involves removal of the prostate and seminal vesicles, and in women, the uterus, ovaries and part of the vagina are removed. Another option, when cystectomy is not feasible, is surgery to preserve kidney function as much as possible by creating an opening for continuous drainage of urine. This is called urinary diversion. The Mayo Clinic describes two approaches to this intervention. In one approach, a tube fashioned from the intestines is attached to the kidneys and runs into a pouch outside the body called a urostomy bag, which can be emptied periodically. The other approach is to build an inner reservoir for urine, a continent urinary, or orthotopic, bladder, which can be emptied with a catheter via a hole, or stoma, on the abdomen, or through the urethra.
Radiation Therapy
Radiation therapy is the use of high powered rays to kill cancer cells or slow their spread. According to the National Cancer Institute (NCI), external beam radiation therapy (EBRT) is the type of radiation used in advanced bladder cancer. It involves the use of external sources of radiation focused on the areas affected by the cancer, and the metastases or areas of spread. It is applied in advanced bladder cancer as a palliative measure. It is may be combined with chemotherapy and radical surgery.
