Stage 3 Bladder Cancer: What to Expect

Medically reviewed by Yamini Ranchod, PhD, MS on July 26, 2017Written by Ann Pietrangelo on July 26, 2017

What is stage 3 bladder cancer?

Bladder cancer is cancer that started in the bladder or lining of the bladder.

Cancer can spread (metastasize) into nearby tissue, or it can use the blood or lymph system to spread to distant sites. Cancer is staged according to how far cancer cells may have spread.

If you have stage 3 bladder cancer, it means that cancer has spread into tissue outside your bladder. In women, it may have spread to their uterus or vagina. In men, it may have spread to their prostate or seminal vesicles. But the cancer hasn’t reached lymph nodes or distant sites. Learn more about the other types of bladder cancer.

Though stage 3 bladder cancer is advanced, it can be successfully treated.

What are the symptoms?

In earlier stages, you probably had some blood in your urine and changes to urinary and bowel habits. In this advanced stage, you may also experience:

  • inability to urinate
  • appetite loss
  • weight loss
  • lower back pain
  • weakness and fatigue
  • swelling of your feet
  • bone pain

What’s the treatment for stage 3 bladder cancer?

The standard treatment for stage 3 bladder cancer is surgery, usually in combination with other therapies.

Be sure to discuss your treatment goals with your doctor. Assess all the potential benefits and risks of each therapy. Some treatments aim for a cure. Others work to slow progression or relieve symptoms. The recommended treatment may depend on your overall health.

If cancer continues to progress or comes back during treatment, you may have to reconsider your options.

Radical cystectomy

This surgical procedure requires general anesthesia and a hospital stay. It involves removing the bladder and surrounding tissues through an abdominal incision or laparoscopically.

In women, the ovaries, fallopian tubes, uterus, anterior vaginal wall, and urethra are removed. In men, the prostate and seminal vesicles are removed. Nearby lymph nodes may also be removed.

You’ll need reconstructive surgery to create a new way to store and pass urine, which can be accomplished several ways:

  • Incontinent diversion is a procedure in which a piece of intestine is used to create a passageway for urine. The urine will flow from your kidneys to a small bag on your abdomen.
  • Continent diversion makes use of a piece of intestine to create a pouch. The pouch is connected to an opening in the skin of your abdomen. You won’t need a bag on the outside of your body, and the pouch can be drained several times a day.
  • Your surgeon can make a new bladder, or neobladder, out of intestine. This will enable you to urinate normally.

Risks of surgery include infection, blood clots, and damage to nearby organs. Some post-surgical pain can be expected, and you may experience some sexual dysfunction.

Chemotherapy

Chemotherapy drugs are given intravenously over several months. This can be done before surgery (a technique called neoadjuvant therapy) to shrink the tumor and get the powerful cancer-killing drugs into your system right away.

Chemotherapy can also be used after surgery (as adjuvant therapy) to destroy any cancer cells that were missed during surgery.

If the cancer is inoperable or you can’t tolerate surgery, chemotherapy alone or in combination with radiation can be used as your primary treatment. Among the side effects are nausea, hair loss, and fatigue.

Radiation

External beam radiation therapy is normally given five days a week for several weeks. Radiation kills cancer cells in a targeted area of your body. It’s usually used in combination with chemotherapy, but can be used alone if you can’t tolerate chemotherapy. Side effects include skin irritation and fatigue.

Radiation can also be used for symptom relief.

Immune checkpoint inhibitors

Checkpoint inhibitors are a class of drugs that harness the immune system to attack cancer cells. These medicines are given intravenously every two or three weeks. Side effects may include fatigue, nausea, and urinary tract infections.

Supportive care

Medications and other treatments can help control side effects and improve quality of life.

Clinical trial

Clinical trails are used to test experimental treatments. Ask your doctor for information on trials that might be a good fit for you.

What are the complications?

At this stage, treatment will likely involve removing your bladder.

Without treatment, or if treatment fails, stage 3 bladder cancer can progress to invade distant tissues and organs.

What does recovery involve?

When there’s no sign of cancer, you’re in a state of remission. Even if you’ve finished treatment, you’ll need plenty of follow-up care. Your doctor will provide a plan for recovery, which may include:

  • information about late or long-term side effects
  • diet, exercise, and self-care recommendations
  • schedule for regular checkups
  • schedule for bladder cancer tests and screening tests for other types of cancer
  • information about signs of recurrence

What is the outlook?

When considering outlook, it’s important to keep in mind that this is a very individual thing. Your doctor has a lot to consider when discussing your outlook, including:

  • age and overall health
  • type of bladder cancer and tumor grade
  • whether this is a recurrence after prior treatment for bladder cancer
  • how well you’re responding to various treatments

Using data compiled from 1988 to 2001, the five-year relative survival rate for stage 3 bladder cancer is about 46 percent. Cancer treatments are rapidly improving, so remember that this is only an estimate and doesn’t include more recent data.

Finding support

If you’re living with stage 3 bladder cancer, you don’t have to go through it alone. Talk to your family and friends, and ask for the help you need. You might also find it helpful to look into support groups where you can connect with others who have cancer.

Your oncologist or treatment center can provide information about support groups and other resources in your area. In the meantime, here are some ways to get started:

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