The tumor invades adjacent organs such as the prostate, uterus and vagina alone (T4a, N0, M0 / D1), or it spreads to the pelvic bone and abdominal wall (T4b, N0, M0 / D1), to pelvic lymph nodes (any T, N1-3, M0 / D1), to abdominal lymph nodes (any T, N4, M0 / D2) or to other organs (any T, any N, M1 / D2).
Almost half of Stage IV cases will be found, during surgery, to have lymph node involvement. The cystectomy fails because metastases occurred before the operation. Over 50 percent of patients with D2 disease die within one year, over 80 percent within two years, and less than 5 percent survive five years.
Standard Treatment Patients with extensive nodal disease should first be treated with chemotherapy . Only if the tumor completely disappears should cystectomy be considered as an adjuvant form of therapy.
Cystectomy, with or without radiation therapy , can be beneficial in a very limited number of T4a, N0-1, M0 cases, but if more than microscopic nodal involvement is found, adjuvant chemotherapy could be used. There is still no clear-cut proof that adjuvant chemotherapy is beneficial, but the prognosis for Stage IV is so poor that some form of additional treatment could be tried, preferably within the context of a clinical study.
Five-Year Survival 5 percent
Investigational
• Chemotherapy and chemoradiation therapy programs.
