Bladder Cancer Stage III

Stage 3 bladder cancer is considered a locally advanced form of the disease, where cancerous tissue has grown beyond the bladder muscle and into surrounding tissues. Though advanced, this stage can be successfully treated with surgery, chemotherapy, or radiation therapy.

Table of contents

• What Is Stage 3 Bladder Cancer?
• Symptoms of Stage 3 Bladder Cancer
• Treatment Options
• Outlook and Survival

What Is Stage 3 Bladder Cancer?

Stage 3 bladder cancer is a type of bladder cancer where the disease has grown through the muscle layer of the bladder wall and spread into the surrounding fatty tissue layer outside the bladder. At this stage, the cancer may have also spread to nearby reproductive organs or tissues. In females, it may affect the uterus or vagina. In males, it may have spread to the prostate or seminal vesicles (glands that produce fluid for semen). However, at stage 3, the cancer has not yet spread to distant parts of the body.^[1]

This stage is often referred to as locally advanced bladder cancer or muscle-invasive bladder cancer. Doctors further divide stage 3 into two substages: stage 3A and stage 3B.^[4]

In stage 3A, the cancer has grown outside the bladder walls and muscles into the surrounding fatty tissue and may affect nearby reproductive organs. At this substage, the cancer has not spread to nearby lymph nodes (small organs that are part of the body’s defense system). Alternatively, stage 3A can also mean the cancer has spread to one lymph node in the pelvis that is not near the major arteries of that region.^[8]

Stage 3B means the cancer has either spread to more than one lymph node not near the major arteries of the pelvis, or has spread to at least one lymph node near the major pelvic arteries.^[8]

Symptoms of Stage 3 Bladder Cancer

In earlier stages of bladder cancer, you may have noticed blood in your urine and changes to urinary habits. As the disease progresses to stage 3, additional symptoms may appear. These can include inability to urinate, loss of appetite, unexplained weight loss, and lower back pain on one side.^[1]

Other symptoms you may experience include weakness and fatigue, swelling of the feet, and bone pain. You may also have a frequent need to urinate, trouble urinating, a weak urine stream, or a burning sensation or pain during urination. Some people feel the urge to urinate even when the bladder is not completely full, or need to urinate multiple times during the night.^[8]

It is important to know that these symptoms are not specific to bladder cancer. Other, more common conditions such as bladder stones, urinary tract infections, an enlarged prostate, or an overactive bladder can cause similar problems.^[8]

Treatment Options

Treatment for stage 3 bladder cancer typically involves a combination of therapies. The standard approach usually includes surgery, often combined with chemotherapy or radiation therapy.^[1]

Chemotherapy

Chemotherapy is almost always offered for stage 2 and stage 3 bladder cancer. It is often given before surgery to shrink the tumor, but can also be given after surgery if it was not already used. Chemotherapy may also be used alone if surgery cannot be done. A combination of chemotherapy drugs that includes cisplatin (a type of cancer-fighting drug) is standard treatment for stage 3 bladder cancer.^[6]

If you are being treated with a bladder-preserving approach, chemotherapy is most often used as part of chemoradiation (chemotherapy combined with radiation therapy). This treatment may include cisplatin or other drugs such as 5-fluorouracil with mitomycin. Chemoradiation is given after a surgical procedure to remove the tumor, so the bladder does not have to be removed entirely.^[6]

Surgery

Surgery is a main treatment for stage 3 bladder cancer. The most common surgical procedure is a radical cystectomy, which involves removing the entire bladder, tissue around the bladder, and nearby reproductive organs. In men, this includes the prostate and seminal vesicles. In women, it includes the uterus, fallopian tubes, ovaries, and part of the vagina.^[1]

Once the bladder is removed, urinary diversion surgery is needed to create a new way for the body to hold and pass urine. Doctors may create an artificial bladder, called a continent reservoir or “neobladder,” which preserves normal voiding function and can greatly improve quality of life.^[9]

A pelvic lymph node dissection is usually performed along with the radical cystectomy, often during the same surgery. This procedure removes lymph nodes from the pelvis to check if cancer has spread.^[6]

In some cases, a bladder-preserving approach may be possible. This involves a transurethral resection of bladder tumor (TURBT), which removes tumors from the bladder through the urethra. This is usually followed by chemoradiation therapy.^[6]

Radiation Therapy

Radiation therapy may be offered for stage 3 bladder cancer. It is often given as part of chemoradiation after a TURBT procedure to preserve the bladder. Radiation therapy may also be used alone if surgery cannot be performed.^[6]

Targeted Therapy and Immunotherapy

Targeted therapy uses drugs to target specific molecules on or inside cancer cells to stop their growth while limiting harm to normal cells. A drug called erdafitinib can be used to treat locally advanced bladder cancer that has certain gene mutations and does not respond to chemotherapy.^[6]

Immunotherapy helps strengthen the body’s immune system to fight cancer. You may be offered an immune checkpoint inhibitor for stage 3 bladder cancer that is still growing during or after chemotherapy, comes back within 12 months of finishing chemotherapy, cannot be treated with surgery or chemotherapy, or has a high risk of returning after surgery.^[6]

Outlook and Survival

Though stage 3 bladder cancer is advanced, it can be successfully treated. The five-year survival rate for stage 3 bladder cancer is approximately 39 percent. This means that about 39 out of 100 people with stage 3 bladder cancer are alive five years after diagnosis.^[1]

Recovery and survival rates are higher for patients who are treated at a comprehensive medical center with a multidisciplinary team of experts. These teams typically include urologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, and social workers who work together to provide the best possible care.^[9]

The general health condition of the patient plays an important role in determining the most appropriate treatment approach. It is the overall health condition, rather than age alone, that can be the limiting factor for certain types of surgery.^[9]