Understanding Advanced (Stage 4) Bladder Cancer

Determining a patient’s overall bladder cancer stage involves combining information that describes the bladder tumor (T), any cancer cells in nearby lymph nodes (N), and any cancer cells that have metastasized (M), or spread, to parts of the body that are distant from the bladder.^1,2,3 This information comes from various diagnostic tests and possible surgery.

Stage IV bladder cancer is the most advanced type. Bladder cancer typically begins to grow in the inner lining of the bladder, called the urothelium. The bladder cancer cells can spread into the muscle of the bladder wall and, in some people, it can continue to spread outside of the bladder and into other parts of the body that are near or far from the bladder.

A diagnosis of stage IV bladder cancer means that the cancer has spread beyond the bladder into areas such as the abdomen, pelvis, lymph nodes, and/or other parts of the body.

What does a Stage 4 bladder cancer diagnosis mean?

Stage 4 bladder cancer includes the following combined TNM stages:^1,2

• [T4b, N0, M0]
• [Any T, N1/N2/N3, M0]
• [Any T, any N, M1]

There are three general types of stage IV bladder cancer. In the type classified as [T4b, N0, M0], the bladder cancer has grown through the bladder muscle and into the wall of the pelvis or of the abdomen. However, the bladder cancer has not spread to lymph nodes near the bladder (N0) and it has not metastasized to distant parts of the body (M0).

In stage IV bladder cancer classified as [Any T, N1/N2/N3, M0], the bladder cancer has spread to at least one of the regional lymph nodes near the bladder.

• N1 means that the cancer has spread to one lymph node in the pelvis.
• N2 means the cancer has spread to at least two lymph nodes in the pelvis.
• N3 means that the cancer has spread to other lymph nodes, called common iliac lymph nodes, that are located above the bladder. However, the bladder cancer has not metastasized to distant parts of the body that are further from the bladder.

In stage IV bladder cancer that is classified as [Any T, any N, M1], the cancer has spread to lymph nodes that are distant from the bladder, or it has spread to other distant parts of the body such as the bones, the liver, or the lungs (M1). In this type of bladder cancer, the cancer may or may not have spread to the lymph nodes near the bladder (any N).

Treatment options for advanced stage bladder cancer

If you are diagnosed with stage IV bladder cancer, your healthcare team will discuss the treatment options that are available to you.³ The available options generally depend on if the cancer has spread to other parts of the body.

Treatments for stage IV bladder cancer that has not metastasized, or spread to other parts of the body, may include chemotherapy treatment, or external radiation therapy with or without chemotherapy treatment. Some patients may have a surgery called a radical cystectomy to remove the entire bladder, which may or may not be followed by chemotherapy. If you have a radical cystectomy, the surgeon will likely create another way for urine to be stored and removed from the body.

Treatment for stage IV bladder cancer that has spread to other parts of the body (such as the bones, liver, or lungs) may include treatment with one or more of the following: chemotherapy, immunotherapy, surgery, or external radiation therapy. Some patients may choose to participate in a clinical trial to investigate new types of treatment for bladder cancer.

What is the survival rate?

People diagnosed with stage IV bladder cancer that has spread to the regional lymph nodes have a relative five-year survival rate of about 36%, which means that around 36 out of 100 people with this stage of bladder cancer are alive five years after they are diagnosed. People diagnosed with stage IV bladder cancer that has metastasized and spread to other parts of the body have a 5-year survival rate of about 5%.⁴

While this type of bladder cancer can be difficult to treat, there are increasingly effective treatment options for advanced bladder cancer currently being developed and brought to the market.