Advanced Bladder Cancer Outlook: Your FAQs

Bladder cancer happens when cells grow out of control in the lining of the bladder. Early stage bladder cancer is contained within the connective tissue or muscle layers of the bladder.

Advanced bladder cancer may be locally advanced or metastatic.

• Locally advanced bladder cancer: This type has spread through the bladder into the layer of fat surrounding the bladder and may or may not have spread to the nearby reproductive organs such as ureters, prostate, uterus, cervix, vagina, or urethra.
• Metastatic bladder cancer: This type has spread to areas of the body far away from the bladder, like the lungs, liver, bones, or pelvic lymph nodes above the major arteries.

Advanced bladder cancer is stages 3 and 4.

The 5-year survival rate for cancer is the proportion of people with a certain type and stage of cancer who are alive 5 years after diagnosis.

Survival rates for bladder cancer depend on whether the cancer has spread. Locally advanced bladder cancer, also known as stage 3 bladder cancer, may or may not have spread to lymph nodes or surrounding organs.

The 5-year-survival rates are as follows, based on 2013–2019 surveillance data:

• 70.9% if the cancer is in the bladder only
• 39.2% if the cancer has spread to the lymph nodes or organs

Every person has a different response to treatment, so survival rates don’t predict an individual’s future.

People can live for several years with advanced bladder cancer.

The 5-year survival rate for metastatic bladder cancer, also known as stage 4 bladder cancer, is 8.3%, based on data from 2013 to 2019. This means that more than 8 people out of 100 whose bladder cancer had spread to other parts of the body lived more than 5 years after diagnosis.

Because survival rates are calculated from past data, it doesn’t take into account increased survival rates that may come from newer bladder cancer treatments.

All advanced bladder cancer is considered muscle-invasive. Muscle-invasive bladder cancer is considered curable with aggressive therapy, including preoperative chemotherapy followed by surgery (removal of the bladder).

Remission is when signs and symptoms of the cancer are reduced or eliminated. If you have no signs or symptoms of bladder cancer 5 years after treatment, some clinicians say the cancer is cured. However, it may come back. Cancer that comes back is called recurrent cancer.

There are many treatments for advanced bladder cancer.

Your doctor may recommend a particular intervention depending on whether the cancer is stage 3 or 4. The tumor grade is also important. A high-grade tumor is aggressive and fast-growing, while a low-grade tumor is slow-growing.

Treatment for stage 3 and 4 bladder cancer may include:

• partial or radical cystectomy to remove the bladder and nearby organs
• chemotherapy before surgery to help improve survival
• immunotherapy to help prevent recurrence
• radiation as an alternative to surgery, administered with chemotherapy

Doctors may also use surgery or radiation as palliative therapy. Urinary diversion, which gives the body another route to expel urine, is often performed with cystectomy or as a palliative treatment. Palliative treatment aims at improving the quality of life.

Metastatic bladder cancer is divided into stages 4A and 4B. When the cancer has metastasized, the cancer cells are in distant parts of the body away from the bladder.

In stage 4A, bladder cancer cells are in the abdominal wall, the pelvic wall, or the lymph nodes above the major pelvic arteries.

In stage 4B, bladder cancer cells are elsewhere in the body, such as in the bones, lungs, or liver.

There are many treatments for stage 4, or metastatic, bladder cancer. Options can include surgery, chemotherapy, and radiation. At all stages of bladder cancer, people may also receive palliative care, which addresses physical, emotional, and spiritual needs.

Before treatment for bladder cancer, you may experience several symptoms. These can also indicate other conditions that are not bladder cancer. If you have a bladder cancer diagnosis, treatment may or may not improve these symptoms.

Bladder cancer symptoms for all stages:

• blood in urine
• pain during urination
• increased urination
• trouble urinating
• bladder spasms (lower abdominal pain)

Additional bladder cancer symptoms in advanced bladder cancer:

• inability to urinate
• loss of appetite
• weight loss
• pain in bones
• pain in one side of lower back
• fatigue or weakness

If you’re receiving treatment for advanced bladder cancer, you may experience side effects. These can change how you feel physically and emotionally. Some common experiences during chemotherapy are nausea, vomiting, and challenges with thinking and remembering. Your doctor may be able to help you manage these side effects.

Survival rates for advanced bladder cancer are the estimated number of people who live for 5 years after diagnosis. The 5-year survival rates for people diagnosed with advanced bladder cancer range from 8.3% to 70.9%, depending on the stage of cancer.

Treatments for the condition include surgery, chemotherapy, radiation, and palliative care. Many people live for many years after a bladder cancer diagnosis, and newer treatment options may increase the survival rates.