Bladder Transitional Cell Carcinoma Stage III

Stage 3 bladder transitional cell carcinoma is an advanced form of cancer where the disease has grown through the muscle layer of the bladder into surrounding tissues, but has not yet spread to distant parts of the body. Though advanced, this stage can be successfully treated with several options available.

Table of contents

• What is Bladder Transitional Cell Carcinoma Stage III
• Associated Anatomy
• Symptoms
• Treatment Options
• Outlook and Survival

What is Bladder Transitional Cell Carcinoma Stage III

Transitional cell carcinoma, also called urothelial carcinoma, is cancer that starts in the cells lining the inside of the bladder. These special cells are called transitional cells because they can stretch when the bladder fills with urine and shrink when it empties.^[1]

urothelial carcinoma, transitional cell cancer

This type of cancer accounts for about 90% of all cases of bladder cancer in the United States.^[1] In stage 3 bladder cancer, the cancerous tissue has grown through the connective tissue and muscle layer into the fat layer surrounding the outside of the bladder.^[3] The cancer may have also spread to nearby organs. In females, it may have reached the uterus or vagina. In males, it may have spread to the prostate or seminal vesicles.^[3]

Stage 3 is further divided into two substages. Stage 3A means the cancer in the fat layer can only be seen under a microscope. Stage 3B means the cancer in the fat layer can be seen on tests or felt by a doctor during an examination.^[5] However, in stage 3, the cancer has not reached distant sites in the body.^[3]

Associated Anatomy

• Bladder
• Bladder muscle wall
• Fat layer surrounding the bladder
• Uterus (in females)
• Vagina (in females)
• Prostate (in males)
• Seminal vesicles (in males)

Symptoms

Blood in the urine, called hematuria, is usually the first noticeable sign of bladder cancer.^[1] In stage 3 bladder cancer, you may experience symptoms beyond those that appeared in earlier stages.^[3]

Common symptoms include:

• Blood in your urine
• Painful urination
• Frequent urination
• Inability to urinate
• Lower back pain
• Persistent low back pain
• Loss of appetite
• Unexplained weight loss
• Weakness and fatigue
• Swelling of the feet
• Bone pain

You should contact a healthcare provider if you notice any of these symptoms.^[1]

Treatment Options

The standard treatment for stage 3 bladder cancer typically involves a combination of approaches. Most often, the whole bladder needs to be removed, but sometimes it may be possible to keep the bladder using what is called a bladder-preserving approach.^[8]

Chemotherapy

Chemotherapy is almost always offered for stage 3 bladder cancer. It is often given before surgery to remove the bladder, which is called neoadjuvant chemotherapy, but it can also be given after surgery if it was not used before.^[17] Chemotherapy may be used alone if surgery cannot be done.^[17]

A combination of chemotherapy drugs that includes cisplatin is standard treatment for stage 3 bladder cancer. The drugs are given through a needle into a vein.^[17] If you are being treated with a bladder-preserving approach, chemotherapy may be combined with radiation therapy, called chemoradiation.^[17]

Surgery

Surgery is a main treatment for stage 3 bladder cancer. A radical cystectomy removes the whole bladder along with tissue around it.^[8] In men, this includes the prostate and seminal vesicles. In women, it includes the uterus, fallopian tubes, ovaries, part of the vaginal wall, and urethra.^[8]

Once the bladder is removed, urinary diversion surgery is needed to create a new way to hold urine and pass it out of the body. With the creation of artificial bladders called continent reservoirs or neobladders that preserve voiding function, radical cystectomy is now a far more acceptable procedure than it once was.^[8]

A pelvic lymph node dissection removes lymph nodes from the pelvis and is usually done following a radical cystectomy, often during the same surgery.^[17]

Radiation Therapy

External radiation therapy may be offered for stage 3 bladder cancer. It may be given as part of chemoradiation after a procedure to remove the tumor through the urethra. External radiation therapy may also be used alone if surgery cannot be done.^[17]

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system’s ability 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, or cannot be treated with surgery or chemotherapy.^[17]

Targeted Therapy

Targeted therapy uses drugs to target specific molecules on or inside cancer cells to stop the growth and spread of cancer while limiting harm to normal cells. It is sometimes used to treat locally advanced bladder cancer.^[17]

Outlook and Survival

Stage 3 bladder cancer is advanced, but it can be successfully treated. The 5-year survival rate for stage 3 bladder cancer is 39%.^[3] This means that 39% of people with stage 3 bladder cancer are alive five years after diagnosis.

Bladder cancer has a high recurrence rate, meaning it often comes back after treatment. Non-muscle invasive bladder cancers can recur in up to 70% of cases within two years of treatment.^[19] Because of this, close follow-up care is very important. Regular monitoring with cystoscopies (bladder inspections with a camera) and possibly additional imaging tests are used to watch for signs of cancer returning or progressing.^[10]

Several factors affect your outlook, including your overall health, how well the cancer responds to treatment, and the specific characteristics of your tumor. Your healthcare team will work with you to develop the best treatment plan based on your individual needs.^[10]