Advanced and Metastatic Bladder Cancer: Symptoms, Stages and Treatment 

Advanced bladder cancer is a general term that may describe bladder cancer that has grown into nearby tissues, organs or lymph nodes near the bladder or in the pelvis, called locally advanced bladder cancer, or cancer that has spread to lymph nodes or organs outside of the pelvis (i.e. distant lymph nodes and distant organs), called metastatic bladder cancer. The stage and location of the cancer help determine which treatments may be appropriate. 

What is locally advanced bladder cancer? 

Locally advanced bladder cancer has grown into nearby tissues, organs or lymph nodes near the bladder or in the pelvis.

What is metastatic bladder cancer?  

Metastatic bladder cancer has spread to lymph nodes or organs outside of the pelvis (i.e. distant lymph nodes and distant organs).

What is the difference between locally advanced and metastatic bladder cancer? 

Locally advanced and metastatic bladder cancer are related terms, but they do not mean the same thing. 

	Locally advanced bladder cancer	Metastatic bladder cancer
What is means	Cancer has grown beyond the bladder into nearby tissue or organs	Cancer has spread to distant lymph nodes or organs
Where it may be found	Tissue surrounding the bladder, prostate or seminal vesicles, uterus or vagina, or pelvic or abdominal wall	Distant lymph nodes, lungs, liver, bones or other distant organs
Possible stages	Usually stage III or stage IVA, depending on whether regional lymph nodes or lymph nodes in the pelvis are involved and where the cancer has grown in the pelvis	Stage IVA when limited to distant lymph nodes or stage IVB when it has spread to distant organs
How it can be treated	Systemic therapy, surgery or combined chemotherapy and radiation, depending on whether the cancer can be treated locally	Systemic treatment, such as antibody-drug conjugates, immunotherapy, chemotherapy or targeted therapy
Treatment goal	Treatment may sometimes aim to eliminate the cancer; in other situations, the goal is to control it and relieve symptoms	Treatment generally aims to shrink or control the cancer, relieve symptoms and help people live longer

What are the symptoms of locally advanced or metastatic bladder cancer? 

Symptoms of advanced bladder cancer vary depending on where the cancer has spread. In addition to common bladder cancer symptoms, people with advanced disease may experience:   

• Being unable to urinate  
• Lower back pain on one side of the body  
• Loss of appetite and unexplained weight loss  
• Increased tiredness or weakness  
• Pain in bones

How is advanced bladder cancer diagnosed? 

Doctors use imaging, tissue samples and lab tests to find out how far bladder cancer has grown or spread. Testing may include:   

• CT or MRI scans: Help determine if the cancer has spread beyond the bladder.   

• Other imaging tests: May be used to look for cancer in other areas of the body.   

• Biopsy and pathology: Confirm the type, grade and characteristics of the cancer. 

• Biomarker or molecular testing: Looks for tumor features that may help guide treatment decisions. 

What stage is advanced bladder cancer?  

Advanced bladder cancer does not always mean stage 4. Depending on how far it has grown or spread, locally advanced bladder cancer may be stage III or stage IVA. 

• Stage III: The cancer has grown into tissue surrounding the bladder, certain nearby organs or regional lymph nodes.  

• Stage IVA: The cancer has grown into the pelvic or abdominal wall, or it has spread to distant lymph nodes.  

• Stage IVB: The cancer has spread to one or more distant organs, such as the lungs, liver or bones.  

Bladder cancer staging is complex. Ask your healthcare team to explain your stage and what it means for treatment. 

What are treatments for advanced bladder cancer? 

Treatment depends on whether the cancer is locally advanced or metastatic, whether it can be removed or treated with radiation, previous treatments, biomarker results and the person’s overall health. These include:   

Antibody-drug conjugate (ADC)  

Combined-modality therapy (CMT)  

Enfortumab vedotin and pembrolizumab  

Immune checkpoint inhibitors  

Maintenance therapy with immune checkpoint inhibitors  

Radical cystectomy  

Systemic chemotherapy  

Targeted therapy 

Treatment options for advanced bladder cancer continue to change. Talk with an experienced bladder cancer specialist about the most current options. 

What is the survival rate of advanced bladder cancer?

Survival rates for locally advanced and metastatic bladder cancer vary widely. It depends on where the cancer has spread, the characteristics of the cancer, overall health and how the cancer responds to treatment. Population survival statistics describe groups of people and cannot predict how long an individual person will live.  

According to the National Cancer Institute,   

• For bladder cancer that has spread to nearby lymph nodes or organs, the 5-year survival rate is approximately 39%.  
• For bladder cancer that has metastasized to a distant part of the body, the 5-year survival rate is around 8%. 

Frequently asked questions about locally advanced and metastatic bladder cancer

Is locally advanced bladder cancer the same as metastatic bladder cancer?   

No. Locally advanced bladder cancer has grown into nearby tissues and organs.  Metastatic bladder cancer specifically means the cancer has spread beyond its original location to distant parts of the body. 

Is metastatic bladder cancer stage 4?

Yes. Bladder cancer that has spread to distant lymph nodes is classified as stage IVA. Cancer that has spread to distant organs is classified as stage IVB. However, not every locally advanced bladder cancer is stage 4. 

What are the symptoms of advanced bladder cancer?

 Symptoms can include difficulty urinating, back pain, bone pain, fatigue, loss of appetite and unexplained weight loss. Symptoms can vary depending on where the cancer has spread. 

Can advanced bladder cancer be treated?   

Yes. Treatments for locally advanced and metastatic bladder cancer can shrink or control cancer, relieve symptoms and help some people live longer. Treatment decisions depend on where the cancer has spread, previous treatments, tumor characteristics and overall health. 

What treatments are available for advanced bladder cancer?  

Treatment may include antibody-drug conjugates, immunotherapy, chemotherapy, targeted therapy, radiation therapy, surgery in selected cases and clinical trials. The appropriate treatment depends on the individual cancer and patient.  

More resources for advanced bladder cancer:  

Clinical trials for bladder cancer 

Bladder cancer treatment matrix  

Support for bladder cancer patients and caregivers  

Podcast: What is Metastatic Bladder Cancer?

Medically reviewed by: Christine Ibilibor, MD, M.Sc.,
Assistant Professor of Urologic Oncology
Last medically reviewed: October 9, 2026