Stage 3 bladder cancer refers to a tumor that reaches outside the bladder. It may have spread into nearby lymph nodes and other tissue.

Like all cancers, doctors use stages for bladder cancer. Staging helps doctors describe the cancer to the person and other medical professionals. It can help guide treatment decisions.

This article reviews what stage 3 bladder cancer is, its possible symptoms, causes, treatment options, and more.

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Stage 3 bladder cancer is a locally advanced type of bladder cancer.

According to the American Cancer Society, stage 3 bladder cancer means the tumor has spread outside the bladder. It may also affect surrounding tissues, such as the local lymph nodes.

At stage 3, the cancer has not spread to distant organs or tissues.

The National Cancer Institute notes that stage 3 bladder cancer breaks down into two substages: 3A and 3B.

Stage 3A bladder cancer

A person with stage 3A bladder cancer meets one of the following conditions.

The first condition occurs when the cancer grows outside the bladder walls and muscles into the surrounding fatty tissue. It may also affect the reproductive organs or tissues, such as the:

  • seminal vesicles
  • prostate
  • vagina
  • uterus

In this substage, the cancer did not spread to nearby lymph nodes.

The second condition for stage 3A bladder cancer occurs if the cancer spreads to one lymph node in the pelvis that is not near the common iliac arteries. These are the major arteries of the pelvic region.

Stage 3B bladder cancer

For a doctor to diagnose stage 3B bladder cancer, the cancer must have either:

  • spread to more than one lymph node not near the major arteries of the pelvis
  • spread to at least one lymph node near the major arteries of the pelvis

Learn more about cancer staging.

Blood in urine, called hematuria, is typically the first symptom of bladder cancer.

Other symptoms include:

  • a frequent need to urinate
  • trouble urinating
  • a weak urine stream
  • a burning sensation or pain during urination
  • feeling the urge to urinate even if the bladder is not completely full
  • needing to urinate multiple times per night

A person may also experience:

  • fatigue
  • loss of appetite
  • unexplained weight loss
  • lower back pain on one side

The symptoms of bladder cancer are typically nonspecific. This means other conditions may be causing them. The American Cancer Society states that other, more common causes of these symptoms can include:

  • bladder stones
  • urinary tract infection (UTI)
  • enlarged prostate
  • overactive bladder

Learn more about the symptoms of bladder cancer.

Scientists do not know the exact cause of bladder cancer. They believe certain changes in genes, either inherited (passed down from parents) or acquired (change occurred throughout a person’s life), may be responsible.

Certain risk factors can increase the chances a person will develop bladder cancer. They include:

  • exposure to certain chemicals in the workplace
  • smoking
  • personal history of bladder or other urothelial cancer
  • family history of bladder cancer
  • previous chemotherapy or radiation exposure
  • use of certain medications, such as pioglitazone for diabetes
  • use of certain herbal supplements, such as those containing aristolochic acid
  • chronic bladder infections or irritation
  • bladder-related birth defects
  • not drinking enough fluids
  • exposure to arsenic in drinking water

Learn more about the causes of bladder cancer.

When a person visits a doctor due to symptoms, such as blood in the urine, the doctor typically reviews the person’s personal and family history and performs a physical examination.

A physical exam may reveal further signs of bladder cancer. A medical history can help a doctor determine whether a person has a high risk for bladder cancer.

Urine tests

If the doctor suspects bladder cancer is the cause of symptoms, they will likely order urine testing. This can include urine tests to check for:

  • blood or other substances in the urine
  • signs of cancerous or precancerous cells
  • specific tumor markers in the urine

Cystoscopy and biopsy

A doctor will likely follow up suspicious test results with a cystoscopy. The test involves a qualified healthcare professional inserting a long, flexible tube with a camera at the end into the urethra to examine the bladder.

If the exam shows an abnormal growth, a doctor may order a transurethral resection of bladder tumor (TURBT) to remove the lump or a portion of it. This is also known as a biopsy.

The doctor then examines the tissue under a microscope to determine whether it is cancer.

Grading the cancer

The biopsy sample can help doctors determine both the grade and invasiveness of the cancer. The grade may be low or high grade. Low grade cancer cells appear similar to normal cells. High grade cancer cells do not.

The invasiveness of the tumor refers to whether it has penetrated the bladder wall. An invasive cancer has grown deeper into the bladder compared with a noninvasive one.

Staging the cancer

Once a doctor determines that the growth is cancerous, they use one or more imaging tests to help stage the cancer. Tests to help determine the stage include:

  • CT scan
  • ultrasound
  • retrograde pyelogram, which uses a thin tube to insert substances to help the tumor show up better on X-rays
  • intravenous pyelogram (IVP), which is an X-ray that uses a special dye
  • bone scan to check whether the cancer has spread to the bones
  • chest X-ray to check for cancer that may have spread to the lungs

Stage 3 bladder cancer is when the cancer has spread to the bladder wall. It may have also spread to nearby tissue and lymph nodes.

If the cancer spreads to distant areas, such as the lungs or bones, it is stage 4 bladder cancer.

Following staging using TURBT, a standard treatment for stage 3 bladder cancer typically involves a radical cystectomy.

A radical cystectomy is an invasive procedure. A surgeon removes the entire tumor, the bladder, and some of the surrounding tissue and lymph nodes.

The surgeon then needs to reconstruct a way to release urine. They may do this by creating a stoma, which is an opening in the abdomen, or by creating a new bladder.

Some people may receive chemotherapy with or without radiation before the procedure. This can help shrink the tumor and make surgery easier.

After the procedure, a person may need additional chemotherapy, immunotherapy, or radiation therapy. These treatments can help destroy any remaining cancer cells.

People who are unable to undergo surgery due to health or other reasons may need one or more of the following therapies:

  • radiation therapy
  • immunotherapy
  • intravesical therapy
  • chemotherapy

If cancer still remains, a person may need a partial or full bladder removal surgery.

A person’s doctor can explain the tests they order and answer any questions a person may have.

Learn more about bladder cancer treatments.

Complications associated with stage 3 bladder cancer may relate to either the tumor, the cancer itself, or the treatments.

Complications associated with the tumor can include:

  • fatigue
  • UTI
  • weight loss
  • metastasis, where the cancer spreads to other areas of the body, such as the lungs or bones
  • urinary obstruction, which can lead to chronic kidney failure

Complications related to surgery may include:

  • UTI
  • urinary tract obstruction
  • pouch stones
  • erectile dysfunction
  • vaginal narrowing
  • urinary leak

Surgeons take steps to minimize the risk of complications of surgery. If complications do develop, a person’s doctor can recommend suitable treatments.

According to the American Cancer Society, the 5-year relative survival rate for regional bladder cancer, which can include stage 3 bladder cancer, is 39%.

This means about 39% of people diagnosed with stage 3 bladder cancer will still be alive 5 years after their diagnosis.

Several factors can impact survival, such as:

  • a person’s age
  • a person’s overall health
  • how the cancer responds to treatment

A doctor can provide a better understanding of an individual’s outlook.

A relative survival rate helps give an idea of how long a person with a particular condition may live after receiving a diagnosis compared with people without the condition.

For example, if the 5-year relative survival rate is 70%, that means a person with the condition is 70% as likely to live for 5 years as someone without the condition.

It is important to remember that these figures are estimates. A person can consult a healthcare professional about how their condition may affect them.

Was this helpful?

Stage 3 bladder cancer is an advanced form of bladder cancer. It typically requires surgery to treat. Doctors may also recommend standard therapies, such as chemotherapy and radiation therapy.

The main symptom of bladder cancer is blood in the urine. As the cancer advances, a person may experience other symptoms or symptoms that worsen over time.

It is best for a person to contact a doctor as soon as they have concerns about bladder cancer. The doctor can order tests to confirm the diagnosis and grade the cancer to recommend the best treatment options.