Stage 3 Bladder Cancer

What is stage 3 Bladder Cancer?

Stage 3 bladder cancer is an indication that the cancer has metastasized (spread through the connective tissue into nearby tissue). In female patients, stage 3 bladder cancer may have spread to their vagina or uterus. In male patients, it may have spread to their seminal vesicles or prostate. However, the cancer has not yet spread to distant sites or the lymph nodes.

It is also referred to as ‘invasive’ or ‘deep’ bladder cancer. The term invasive is used to describe whether the cancer has spread into the bladder wall. Non-invasive cancer means that the car is still in the inner cell layers.

A number of factors go into influencing a patient’s decision to receive cancer treatment. The goal of treatment is to improve symptoms by controlling the cancer and increasing the patient's longevity. The risks of receiving cancer treatment must be compared with the benefits for the patient.

What are the subtypes of stage 3 Bladder Cancer?

There are three general subtypes of stage 3 bladder cancer, and the classification itself has evolved in the past several years. The most widely used staging system divides stage 3 into stages IIIA and IIB.

Stage IIIA is when the cancer has spread through the bladder’s wall and muscles into the tissue surrounding the bladder. It may also have spread to the reproductive organs (including seminal vesicles, uterus, prostate, or vagina). However, the cancer has not yet spread to the lymph nodes.

Stage IIIA cancer may have also spread to one lymph node in the pelvis that isn't near the major arteries in the pelvis, known as the common iliac arteries.

Stage IIIB bladder cancer is when the cancer has spread to more than one lymph node in the pelvis that isn’t near the common iliac arteries or at least one lymph node that is in close proximity to the common iliac arteries [¹].

Stage 3 Bladder Cancer staging and diagnosis

Bladder Cancer staging

In general, the TNM system is used to describe and classify cancers, including Bladder Cancer, where:

T (tumor) describes the size and location of the tumor
N (nodes) indicates whether or not it has spread to nearby lymph nodes
M (metastasis) describes if and how far the cancer has spread from its origin

How common is stage 3 Bladder Cancer?

Bladder cancer is highly prevalent in North America, and the average age of diagnosis is 73. In general, 1 in 28 men will develop this cancer in their lifetime. By contrast, there is a 1 in 91 chance that women will develop bladder cancer [²]. According to an estimate by the American Cancer Society, around 82,290 causes of bladder cancer have been reported in 2023 alone.

Nearly 16,710 deaths have been attributed to bladder cancer in both men and women. The good news, however, is that the rates of bladder cancers and deaths from the diseases have been observed to drop in recent years.

How is stage 3 Bladder Cancer diagnosed?

Stage 3 bladder cancer is diagnosed by performing a number of tests and evaluating the patient’s overall signs and symptoms. Urine tests are the most common indicator of bladder cancer and help in the identification of tumor cells.

Around this time, doctors may also take a cystoscopy for bladder cancer. The procedure allows doctors to see inside the body using a flexible tube called a cystoscope. The use of a cystoscope doesn't require anesthesia. A cystoscopy can easily detect growths in the bladder and determine the need for surgery or a biopsy.

If doctors find the presence of abnormal tissue, they may perform a biopsy for further confirmation. In the case of bladder cancer, the biopsy is referred to as a transurethral bladder tumor resection (TURBT). The doctor will collect a sample of the bladder muscle near the tumor.

Analysis of the sample may then help them decide if more tissues from surrounding sites should be collected. Doctors often perform EUA (exam under anesthesia) before completing a TURBT to evaluate the bladder to see if any masses can be felt.

A computed tomography scan is often used to help with staging. During this process, several pictures of the inside of the body are taken using X-rays from different angles. The data is then used to create a 3D image of the tumors. The CT scan reveals vital information such as tumor size and where cancer has spread [³].

Other tests used to help with staging bladder cancer include:

Bone scans: This involves the use of a radioactive tracer to look inside the bones
PET-CT scan: Combines a PET scan with a CT scan to create a more detailed picture of the tissues inside the body.
Ultrasound: Uses sound waves to create an image of the internal organs. Unlike MRI and CT scans, ultrasound scans do not require the use of a contrast medium [⁴].
MRI scans: Often used to measure the tumor size and help find out if the cancer has spread.

Stage 3 Bladder Cancer Symptoms

The most common indicator of stage 3 blood cancer is the presence of blood in the urine. The medical term for this is hematuria, and it is often painless. Patients may also notice streaks of blood in their urine, or the blood may turn the urine brown. The presence of blood isn’t easy to notice.

Other symptoms of stage 3 bladder cancer include:

Pelvic pain
Bone pain
Swelling in the legs
Weight loss due to decreased appetite since the cancer has spread to other organs and affects how essential organs are functioning [⁵]
Having to urinate more frequently
An extreme urge to urinate without any forewarning
A burning sensation when urinating (also known as dysuria)
Feeling lethargic
Pain on one side of the body
Having to wake up at night with an overwhelming need to urinate

Stage 3 Bladder Cancer treatment

Doctors have access to several treatment options for treating stage 3 bladder cancer, including surgery, chemotherapy, radiation, and the use of immune checkpoint inhibitors. In some cases, surgery may not be the right option if doctors believe that the risks outweigh the benefits. Patients should discuss their treatment goals with their doctor and assess all the potential benefits as well as risks of each therapy.

Some treatments aim to cure stage 3 bladder cancer, while others work to slow progression and improve the quality of life. In general, the treatment protocol for stage 3 bladder cancer depends on the patient's overall health.

Stage 3 Bladder Cancer {primary/first-line treatment}

The primary treatment for stage 3 bladder cancer starts with surgery that requires a hospital stay as well as general anesthesia. This surgery involves the removal of the bladder, surrounding tissues, and seminal vesicles in men. In the case of women, radical cystectomy involves the removal of fallopian tubes, ovaries, uterus, anterior vaginal wall, and urethra.

Depending on how far the cancer has spread, a radical cystectomy may also accompany the dissection of the pelvic lymph node. Although radical cystectomy sounds like a life-altering procedure, the advancement of artificial bladders, also known as neobladders, preserves the voiding function in patients. As a result, cystectomy is a more acceptable procedure.

Although it is not common for the cancer to return because of the removal of the cancer, it is possible for local recurrence. This is why patients may be prescribed cystectomy before cystectomy. Treatment with chemotherapy can reduce or eliminate undetected cancer cells, such as micro-metastases, that have spread to other locations in the body prior to the removal of the bladder.

Depending on the patient's symptoms, the doctor may recommend both chemotherapy and radiation therapy as primary treatments. Or they may prescribe one over the other as primary treatment. Chemotherapy without radiation therapy is often used for patients with inoperable stage III cancer.

Radiation therapy alone is used for bladder cancer in patients who cannot tolerate chemotherapy.

Reconstructive surgery is performed to create a new way of storing and passing urine. A common route is making a new bladder out of the intestine to allow the patient to urinate normally.

Other types of treatment for stage 3 Bladder Cancer

Stage 3 bladder cancer can be treated with other protocols, including:

Chemotherapy combined with biologic agents: This treatment combines biologic agents with chemotherapy
Immune checkpoint inhibitors: These drugs use the immune system to attack cancerous cells. The medicine can be administered intravenously once every two to three weeks. Side effects include nausea, urinary tract infections, and fatigue.
Supportive care: This treatment refers to managing or preventing the side effects of the treatment. Medications may be prescribed to help improve the patient's quality of life.

Can stage 3 Bladder Cancer be cured?

Stage 3 bladder cancer can be cured. Successful treatment of the condition depends on various factors, including the patient's lifestyle, how soon doctors are able to diagnose and administer treatment, and genetics.

Prognosis: Stage 3 Bladder Cancer survival rate

Stage 3 Bladder Cancer survival rate

Studies show that around 40% (or 40 out of 100) of people survive stage 3 bladder cancer for five years or more after diagnosis [⁶]. The survival rate depends on various factors, including whether the patient has non muscle invasive bladder cancer or muscle-invasive bladder cancer.

Stage 3 Bladder Cancer recurrence rate

Stage 3 bladder cancer has a high recurrence rate of up to 50% in people who have undergone transurethral resection of bladder tumor (TURBT) [⁷]. A 2013 study of 7410 subjects found that nearly 39.1% (or 2897) of patients experienced a recurrence without progression. 981 of these patients died because of bladder cancer [⁸].

Stage 3 Bladder Cancer growth rate

The growth rate of stage 3 bladder cancer is slow, which makes them harder to detect and treat. The exact growth rate depends on the grade of the cancer. For example, low-grade cancer cells are slow growing, while high-grade cancers grow very quickly. Most bladder tumors are low-grade [⁹].

Lifestyle changes for preventing and managing Bladder Cancer

It is recommended for patients to make several lifestyle changes to not only manage the symptoms of bladder cancer but also prevent disease progression, if possible.

Working out regularly: Exercising has several benefits that can boost energy levels and improve the immune system.
Managing fatigue: Fatigue is a common symptom associated with bladder cancer and should be treated. This means sleeping adequately and managing stress levels.
Finding a support group: It can be difficult to cope with bladder cancer because patients are reeling in with uncertainty and anxiety. Having a support group helps the person cope better. Some of the most common sources of support include family and friends, religious groups, and social workers.
Eating a healthy diet: It is recommended for patients to eat a healthy diet that includes a variety of vegetables, whole grains, poultry, fish, and low-fat dairy products. These food groups will manage the symptoms of bladder cancer and help them stay hydrated.

Conclusion

Takeaway

Treatment of stage 3 bladder cancer depends on a number of factors, including the patients' age, lifestyle, and cancer grade. It can be successfully cured; however, cancer recurrence is possible. It is recommended for patients to follow up with their physicians and pathologists who specialize in stage 3 bladder cancer to effectively manage and treat the disease.