Metastatic stage 4 bladder cancer

This page was reviewed under our medical and editorial policy by

Bertram Yuh, MD, MISM, MSHCPM, Urologic Surgeon, City of Hope | Duarte

This page was updated on March 8, 2024.

Metastatic bladder cancer is also referred to as stage 4 bladder cancer or advanced bladder cancer. Metastasis is a process where cancer cells break away from a tumor and travel through the lymphatic system or bloodstream to other parts of the body.

Metastatic bladder cancer develops in the bladder and spreads outside, sometimes forming tumors in other organs, bones or body tissues. Metastatic cancers are named after their place of origin. For example, metastatic bladder cancer that has invaded the liver, is still called metastatic bladder cancer.

What is stage 4 bladder cancer?

Stage 4 bladder cancer is cancer that has spread beyond the bladder. Doctors may use different terms to refer to this type of disease, including:

  • Stage 4 bladder cancer
  • Advanced bladder cancer
  • Metastatic bladder cancer

The health care team will establish the bladder cancer stage following diagnosis. Stage 4 is considered the most advanced stage.

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Bladder cancer metastatic sites

Advanced bladder cancer is more likely to spread to certain parts of the body. Common sites may include:

In rare cases, bladder cancer may also spread to the brain.

Stage 4 bladder cancer substages

When bladder cancer cells spread and form tumors in other parts of the body, the disease is classified as stage 4, or advanced bladder cancer. These new tumors may develop in one or more parts of the body, such as the bones, lymph nodes or urinary tract. Stage 4 bladder cancer comprises the two subtypes listed below.

Stage 4A: The cancer has spread outside the bladder into nearby areas, such as the abdominal wall or pelvic wall. It may have also traveled to the lymph nodes.

Stage 4B: The disease has traveled further to invade one or more distant tissues or organs, such as the bone, lungs, liver or abdominal lining.

Metastatic bladder cancer symptoms

Patients with metastatic bladder cancer may notice different symptoms than those generally associated with other stages of the disease. In addition, the symptoms may depend on where the cancer has spread. Some of the most frequently occurring stage 4 bladder cancer symptoms include:

  • Changes in urinary function
  • Unexplained weight loss
  • Fatigue
  • Unexplained pain

Not everyone with metastatic bladder cancer will experience each of these symptoms, but patients should speak with their care team if they notice any such changes.

Metastatic stage 4 bladder cancer treatment

Chemotherapy, which may or may not be combined with radiation therapy, is the most common first-line treatment for locally advanced and metastatic stage 4 bladder cancer. Depending on the results and the patient’s symptoms, a doctor may also recommend:

  • A different type of chemotherapy
  • More radiation therapy
  • An immunotherapy drug
  • Surgery

Surgery for bladder cancer is called a cystectomy. A segmental or partial cystectomy removes part of the bladder while a radical cystectomy removes the entire bladder and nearby lymph nodes.

If a radical cystectomy is performed, a urinary diversion procedure is needed to allow urine to flow out of the body in a different way. Sometimes, a urinary diversion procedure (urostomy) may also be done without a cystectomy to prevent or eliminate a blockage of urine that could lead to kidney damage. Several types of urostomy procedures are available.

Because advanced bladder cancer is challenging to treat, these methods are usually aimed at slowing the disease’s progression, extending lifespans and alleviating metastatic bladder cancer symptoms, such as inability to urinate, pain and fatigue. Some patients may also take part in a clinical trial, which studies new treatments for bladder cancer.

Stage 4 bladder cancer survival rate

According to the American Cancer Society, for patients with locally advanced disease, where the cancer has spread to nearby tissues, the five-year relative survival rate is 39 percent. The five-year relative survival rate for patients with metastatic bladder cancer, where cancer cells have spread to distant parts of the body, is 8 percent.

These numbers represent averages based on research from 2012 to 2018. Treatments tend to improve with time, and patients diagnosed with stage 4 bladder cancer today should discuss their individual prognosis with their doctors.

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Show references

American Society of Clinical Oncology (2022, July). What Is Metastasis? https://www.cancer.net/navigating-cancer-care/cancer-basics/what-metastasis

American Cancer Society (2020, September 10). Understanding Advanced and Metastatic Cancer. https://www.cancer.org/cancer/managing-cancer/advanced-cancer/what-is.html

Cancer Research UK (2022, December 22). What is metastatic bladder cancer? https://www.cancerresearchuk.org/about-cancer/bladder-cancer/metastatic/what-is

American Cancer Society (2019, January 30). Bladder Cancer Stages. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/staging.html

National Cancer Institute (2023, February 16). Treatment of Bladder Cancer by Stage. https://www.cancer.gov/types/bladder/treatment/by-stage

National Cancer Institute (2023, April 27). Bladder Cancer Diagnosis. https://www.cancer.gov/types/bladder/diagnosis

American Cancer Society (2022, December 19). Treatment of Bladder Cancer, by Stage. https://www.cancer.org/cancer/types/bladder-cancer/treating/by-stage.html

American Cancer Society (2019, January 30). Bladder Cancer Signs and Symptoms. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html

American Cancer Society (2023, March 1). Survival Rates for Bladder Cancer. https://www.cancer.org/cancer/bladder-cancer/detection-diagnosis-staging/survival-rates.html