With any big change in life, we often want to know how things will turn out. Uncertainty is hard to live with, especially when it comes to a cancer diagnosis. If you or a loved one has been diagnosed with bladder cancer, you may be wondering whether it will spread to other parts of the body and what to expect.

Your healthcare team is your best resource for answers and information, but no one can say for sure how your cancer will progress. However, there are some factors that affect whether and how bladder cancer spreads. In this article, we’ll discuss the different types, stages, and grades of bladder cancer and how all these factors can influence cancer spread.

What Types of Bladder Cancer Are There?

Typically, bladder cancer starts in the cells that line the inside of the bladder. From there, some cancers spread outward through the layers of the bladder. Cancer cells can also keep spreading to reach nearby organs and eventually faraway organs such as the lungs or liver. The most important factors that determine if and how fast a bladder cancer will spread are the cancer type, stage, and grade.

Bladder cancer is classified according to three factors:

• Type of cancer — Where the cancer started and the type of cell involved
• Grade — How aggressive the cancer cells look under the microscope
• Stage — What size the cancer is and whether it has spread

Your healthcare team may also use the terms “non-muscle-invasive,” “muscle-invasive,” or “metastatic” to describe your bladder cancer diagnosis. Below, we’ll discuss all these categories and how they relate to bladder cancer spread.

Type of Cancer

Over 90 percent of bladder cancers diagnosed in the United States are urothelial carcinomas. This type of cancer is also called transitional cell carcinoma. Urothelial carcinoma starts with a cell type called urothelial cells found on the inside of your bladder. Other bladder cancer types exist, such as squamous cell carcinoma and adenocarcinoma. In particular, adenocarcinoma of the bladder is an aggressive cancer that is more likely to spread. This type of cancer makes up about 1 percent to 2 percent of all bladder cancer diagnoses.

Cancer Grade

Another important cancer classification is the grade. The grade can give important information about how likely the cancer is to spread and come back after treatment. Grades range from 1 to 3, with a low grade (e.g., grade 1) meaning that the cancer is less likely to spread or recur (come back) after cancer treatment.

A high-grade cancer (e.g., grade 3) has more aggressive features and is more likely to spread. One study from 2024 found that 32 percent of people with high-risk non-muscle-invasive bladder cancer (NMIBC) experienced cancer spreading to the muscle wall to become muscle-invasive cancer. One study showed that it took an average of 82 months for that spread to occur, though this can happen earlier for some people.

Cancer Stage

The most common way that healthcare providers describe the stage of bladder cancer is using the TNM staging system. TNM stands for “tumor, node, and metastasis.” Higher numbers in each of these categories mean the cancer has spread more and is more advanced.

• Tumor — Describes how big or how deep the tumor is
• Node — Refers to whether the cancer has spread to any lymph nodes and how many lymph nodes (small glands found throughout your body that drain waste fluid and dead cells) are involved
• Metastasis — Describes whether the cancer has spread to any part of the body outside of the bladder

Once your healthcare team has determined your TNM categories, they’ll use this information to assign your cancer an overall stage. The stages of bladder cancer range from 0 to 4, with substages in between. The lower the stage, the less the cancer has spread and the better the outcome.

Non-Muscle-Invasive

Non-muscle-invasive bladder cancer means that your bladder cancer is only in the inner lining of the bladder. This term is used only for the most common type of bladder cancer, urothelial carcinoma. NMIBC is less likely to spread than muscle-invasive bladder cancer (MIBC). This is also the most common subcategory of bladder cancer diagnoses, making up 75 percent of all bladder cancer cases.

In general, non-muscle-invasive bladder cancer is at an early stage. This type of cancer is sometimes also divided into risk groups, including low-, intermediate-, and high-risk cancers. The risk group refers to how likely the cancer is to spread or come back after treatment.

Muscle-Invasive

When bladder cancer moves past the inner lining of the bladder and into the muscle layer surrounding it, it becomes muscle-invasive bladder cancer. MIBC is more likely to spread than non-muscle-invasive cancer, and it is usually treated more aggressively. In about 10 percent of cases, NMIBC cancer can progress to muscle-invasive bladder cancer when it reaches the deeper muscle layer of the bladder.

Metastatic

When bladder cancer spreads past the bladder into other parts of the body, such as lymph nodes outside the pelvis or the lungs, liver, brain, or bones, it’s called metastatic bladder cancer.

Where Does Bladder Cancer Spread?

When bladder cancer invades the muscle wall of the bladder, it’s classified as stage 2. In stage 3, the cancer grows past the muscle wall of the bladder and moves outward to nearby tissues. It can reach the prostate, uterus, and vagina, all of which are near the bladder. Bladder cancer can also spread to the nearby lymph nodes in the pelvis. This stage is also called locally advanced bladder cancer.

Next, cancer cells spread to parts of the body that are farther away. At this point, it’s stage 4 cancer. Your healthcare team might also call it metastatic bladder cancer. This metastasis, or spread, happens because the cancer moves through the bloodstream or the lymphatic system — the system of tubes connecting lymph nodes with tissues throughout your body. Using the blood or lymphatic system, cancer cells can reach distant lymph nodes in your abdomen as well as organs like the lungs, bones, brain, and liver.

What Factors Affect How Fast Bladder Cancer Spreads?

Research on the factors that can affect how bladder cancer progresses and spreads is still in the early stages. In general, we don’t know very much about why some cancers become metastatic or how to predict when and how fast a cancer will spread. However, a few different factors have been associated with better outcomes. More recently, researchers have also learned that certain tumor characteristics increase the risk of metastasis. For example, some specific genetic mutations can increase a bladder tumor’s aggressiveness.

Bladder Cancer Treatment

Prompt treatment is important to reduce the risk that bladder cancer will continue to grow and spread. One study found that when no treatment was given, 38 percent of people diagnosed with muscle-invasive bladder cancer developed metastatic bladder cancer within six months.

Some options for treating early-stage bladder cancer include:

• Surgical removal of cancer from the bladder, called transurethral resection of the bladder tumor (TURBT)
• Radiation therapy before or after surgery
• Intravesical chemotherapy, in which the medication is inserted directly into the bladder via a catheter
• BCG treatment, a type of immunotherapy where weakened bacteria are inserted into the bladder via a catheter

Early Detection

In general, the earlier you’re diagnosed, the better chance you have of a good outcome. This is because a more invasive cancer caught earlier can potentially be treated before it spreads to other parts of the body. Non-muscle-invasive bladder cancer can often be cured, for instance.

For these reasons, being aware of bladder cancer symptoms and talking to your doctor about any new changes is very important. The most common symptom of bladder cancer is blood in the urine. Many things can cause bloody urine other than cancer, but if your doctor suspects bladder cancer, they’ll order laboratory tests.

Although screening for bladder cancer isn’t currently recommended for the general population, some people who are at higher risk can be screened. Ask your healthcare provider if they recommend regular screening for bladder cancer.

Sex

An additional factor that affects bladder cancer spread is sex. According to StatPearls, men are four times more likely to develop bladder cancer, while women tend to be diagnosed later. This means that the cancer is more likely to occur at a later stage, spread further, and be more difficult to treat. According to the Bladder Cancer Advocacy Network, women are also more likely to start treatment later, which also impacts the rate at which bladder cancer will spread.

Lifestyle Factors

A study from 2021 found that people with diabetes and excess body weight (high body mass index, or BMI) may be at higher risk of bladder cancer spread. People with these conditions were also more likely to have their cancer come back after treatment. If you have either of these lifestyle factors, talk to your doctor about how your treatment and follow-up plan may be affected.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you been diagnosed with bladder cancer? Do you want to know more about how and why this type of cancer spreads? Share your experience in the comments below, or start a conversation by posting on your Activities page.