Stage 3 bladder cancer is considered locally advanced. In this stage, the cancer has grown through the muscle layer and into the fat layer surrounding the outside of the bladder. It may have also spread to nearby organs such as the uterus, vagina, seminal vesicles, prostate, or pelvic lymph nodes. Cancer stages are often written using Roman numerals, ranging from I (earliest stage) to IV (most advanced stage).

Bladder cancer stage is one of the most important factors doctors consider in selecting the best treatment and predicting your prognosis (outcome). In this article, we’ll review what it means to have stage 3 bladder cancer, the symptoms you may experience, and other details.

How Is Bladder Cancer Stage Determined?

Several tests can help your cancer care team determine the cancer stage.

A cystoscopy and transurethral resection of a bladder tumor are procedures that allow your health care provider to look inside your bladder and take a tissue sample (biopsy).

When examined under a microscope, a bladder tissue sample can help determine how deep into the bladder wall the cancer has spread (metastasized). When the cancer hasn’t grown into the muscle layer of the bladder, it’s called non-muscle-invasive bladder cancer. When the cancer has grown into the layer of muscle, it’s called muscle-invasive bladder cancer. Tissue that’s removed during bladder cancer surgery may give more accurate information about the stage.

Imaging tests create detailed pictures of your body to check if the cancer has metastasized to other areas.

Your cancer care team can use the information gathered in these tests to determine your stage with a staging system. Cancer staging is a complex process with many factors to consider. If you have questions about your cancer stage, talk to your cancer care team.

Bladder Cancer Staging System

The TNM system is the most common staging system used for cancer. In this system, each letter stands for a piece of information to help determine the stage, as follows:

• T stands for tumor. It represents how deep the cancer has spread into the bladder wall and nearby tissues.
• N stands for lymph nodes. It represents whether or not cancer has spread to nearby lymph nodes.
• M stands for metastasis. It represents whether the cancer has metastasized to distant parts of the body.

There are five stages of bladder cancer, ranging from stage 0 to stage 4. In general, the more advanced the stage is, the more the cancer has spread, while early-stage cancer hasn’t spread from the site where it started. Your cancer stage may also include letters based on specific characteristics. Earlier letters represent less advanced cancer.

What Is Stage 3 Bladder Cancer?

Stage 3 bladder cancer is usually described as cancer that spreads through the muscle layer of the bladder wall to reach the layer of fat that surrounds the bladder. Stage 3 bladder cancer is further divided into two stages — stage 3A and stage 3B.

Although stage 3 bladder cancer may have spread to nearby tissues and organs, it hasn’t spread to distant parts of the body. If this occurs, it’s known as stage 4 bladder cancer or metastatic bladder cancer.

Stage 3A Bladder Cancer

Stage 3A bladder cancer can happen in a few ways. The tumor has grown through the muscle layer into the fat layer around the bladder (T3a or T3b) without spreading to lymph nodes (N0). It may also spread to nearby organs like the uterus, vagina, or prostate (T4a) but still hasn’t reached lymph nodes (N0). Another possibility is that the cancer has spread to one lymph node in the pelvis (N1). In all cases, the cancer has not metastasized to distant parts of the body (M0).

Stage 3B Bladder Cancer

Stage 3B bladder cancer means the cancer has spread to two or more lymph nodes in the pelvis (N2) or at least one lymph node near the common iliac arteries (N3). Tumors in stage 3B range from T1 to T4a, meaning they have grown into the bladder wall but haven’t reached the abdominal or pelvic walls. Like stage 3A, stage 3B bladder cancer has not spread to distant parts of the body (M0).

Symptoms of Stage 3 Bladder Cancer

Stage 3 bladder cancer symptoms may include urinary symptoms, as well as other symptoms related to where the cancer has spread.

Urinary symptoms of stage 3 bladder cancer may include:

• Hematuria (blood in the urine)
• Frequent or urgent urination
• Getting up at night to urinate
• Painful urination

Additional symptoms in people with stage 3 bladder cancer can be related to large tumors or cancer that’s spread to other tissues. In some cases, you or your health care provider may be able to feel a lump in your stomach or pelvis caused by a large tumor. A large tumor might also block the flow of urine. This blockage can result in difficulty or inability to urinate. You may also have lower back pain that’s worse on one side. If cancer has spread to nearby organs, you may also experience pain in your stomach or pelvis.

If bladder cancer has spread to your lymph nodes, it can cause swelling or pain around the affected lymph node. It can also cause swelling in your lower legs and feet. That’s because lymph nodes help drain extra fluid. If drainage is blocked by cancer cells in the lymph node, the fluid can back up, causing swelling.

Some people can also experience general symptoms related to bladder cancer, such as loss of appetite, weight loss, and fatigue (extreme tiredness).

Treatment Options for Stage 3 Bladder Cancer

The two main treatments for stage 3 bladder cancer are surgery or a combination of chemotherapy and radiation therapy.

Surgery for stage 3 bladder cancer usually involves removing the entire bladder, a procedure called a radical cystectomy. This approach also entails a procedure to create a new way for urine to leave your body, known as a urinary diversion.

Before surgery, you may receive medications called neoadjuvant therapy. They work to shrink the tumor and kill cancer cells that surgery might miss. Examples include chemotherapy drugs such as cisplatin (Platinol) and gemcitabine.

Your cancer care team may recommend additional treatment after surgery if the cancer has spread to your lymph nodes or has a high risk of recurrence (coming back after treatment). Additional treatments may include chemotherapy, radiation therapy, or the immunotherapy drug nivolumab (Opdivo).

If surgery isn’t an option or you choose not to have it, your main treatment may include a combination of chemotherapy and radiation therapy, known as chemoradiation, to shrink the tumor. Chemotherapy often uses the drug cisplatin, which can make radiation therapy more effective. Your oncologist might also suggest joining a clinical trial for stage 3 bladder cancer to explore new treatment options.

Your treatment options may differ. Cancer stage is one of the main factors in choosing the most appropriate bladder cancer treatment. However, your cancer care team will also consider factors, such as the number of tumors, the cancer grade, and your overall health and preferences.

What Is the Survival Rate of Stage 3 Bladder Cancer?

Survival rate refers to the percentage of people who are still alive after a set period of time after cancer diagnosis or treatment. A common measure of survival rate is the five-year relative survival rate — the likelihood of surviving at least five years compared to the general population.

In the United States, the National Cancer Institute keeps track of cancer survival rates. The five-year relative survival for everyone with bladder cancer is 78.4 percent. The survival rate is further broken down by stage. Instead of using the TNM staging system, cancers are grouped by how far they’ve spread — localized, regional, or distant.

Stage 3 bladder cancer is classified as a regional stage cancer because it may have spread beyond the bladder to nearby organs or lymph nodes. The five-year relative survival for people with regional bladder cancer is 39.5 percent. However, new treatments for bladder cancer may help increase the survival rate for people with stage 3 bladder cancer.

People with stage 3 bladder cancer also have a high risk of recurrence. There’s about a 70 percent risk that stage 3 bladder cancer will eventually come back after treatment. Talk to your oncology team about the risk factors influencing your prognosis and how often you should schedule follow-ups after treatment is complete. At this advanced stage, it’s important to know there are treatment options that can help, and you don’t have to face this journey alone.

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 or a loved one been diagnosed with stage 3 bladder cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.