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Facts About Stage 4 Bladder Cancer

Bladder cancer


If you have stage 4 bladder cancer, it means your cancer has spread to any or all of the following places:

  • your abdominal wall
  • your pelvic wall
  • your lymph nodes
  • distant parts of your body

Doctors sometimes call stage 4 bladder cancer “metastatic” bladder cancer. It’s typically hard to treat stage 4 cancers.


According to the American Cancer Society, approximately 81,190 people in the United States are diagnosed with bladder cancer each year.

Most bladder cancers are diagnosed at an early stage, when they’re easier to treat. About half of all bladder cancers are found while the cancer is still only in the inner layer of the bladder wall. About 1 in 3 bladder cancers invade into deeper layers, but are still confined to the bladder.

Only about 4 percent of bladder cancers spread to distant areas of the body.

Risk Factors

  • Smoking. About half of people diagnosed with bladder cancer have a history of smoking.
  • Being older. Bladder cancer rarely occurs in people younger than age 40.
  • Being white. White people have a higher risk of developing bladder cancer compared to black or Hispanic people.
  • Being male. Of the new cases of bladder cancer diagnosed in 2018, over 62,000 are men, and only about 18,000 are women.
  • Exposure to chemicals. Certain chemicals, like arsenic and those found in dyes, rubber, and paint, may increase your odds of bladder cancer.
  • Family history. You’re more likely to have bladder cancer if a close family member also has the disease. Some hereditary conditions may further increase this risk.
  • Chronic bladder inflammation. Frequent urinary infections or other problems may make you more apt to develop a specific type of bladder cancer.
  • Past cancer treatments. The chemotherapy drug cyclophosphamide and radiation treatments can both raise your chances of developing bladder cancer.

You might be more at risk for stage 4 bladder cancer if you ignore symptoms of the disease or don’t seek prompt treatment. A stage 4 diagnosis can happen even if you do see a doctor about your symptoms right away, however.

Warning Signs

Warning signs of stage 4 bladder cancer might include:

  • blood in your urine
  • frequent urination
  • pain or burning while urinating
  • feeling like you need to urinate but not being able to
  • back or pelvic pain


Although stage 4 bladder cancer is considered hard to treat, there are options available. Treatments are usually done to slow the cancer’s growth, help you live longer, and make you feel better.

Your physician may recommend surgery in some situations, but often surgery isn’t a good choice for people in stage 4 because all the cancer can’t be removed.

Chemotherapy is usually the first treatment your doctor will suggest if your cancer has spread to distant areas of your body. Two common chemo regimens for bladder cancer include:

  • gemcitabine (Gemzar) and cisplatin
  • methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin

If chemo shrinks your cancer significantly, your doctor might recommend a cystectomy, or surgery to remove all or part of your bladder.

Radiation therapy is another option for treatment. It’s used alone or in combination with chemo.

Sometimes, people with stage 4 bladder cancer are also given immunotherapy drugs like atezolizumab or pembrolizumab (Keytruda).

You may also choose to take part in clinical trials to gain access to new treatments that could help you live longer.


Some people with stage 4 bladder cancer may experience complications.

If you had surgery to remove part of your bladder, you might need to urinate more often because your bladder is smaller.

Surgery to remove all of your bladder may require doctors to create a new way for you to pass urine, such as a urostomy or a new bladder. With a urostomy, a plastic bag is attached to an opening in your abdominal wall to collect urine.

Other potential complications of surgery include infertility, early onset of menopause, and sexual dysfunction in women. Men may also experience sexual dysfunction and infertility.

Living With Stage 4 Bladder Cancer

Following a diagnosis of stage 4 bladder cancer, you might have to make important decisions about which treatments are necessary and which you can pass up.

As your cancer progresses and advances, you may experience:

  • pain
  • weakness
  • loss of appetite
  • tiredness

Listen to your body, and don’t do too much. Rest when you’re tired so you can build up strength. Your doctor can prescribe certain medications to help effectively control your pain.

It’s a good idea to identify close family members and friends who can help you with everyday activities, such as driving to doctors’ appointments or shopping for groceries.


Bladder cancer that’s spread to other parts of your body is typically difficult to treat, but not untreatable. Stage 4 bladder cancer has a relative five-year survival rate of about 15 percent.

It’s important to remember that survival rates are only estimates and don’t apply to everyone. Each particular case is different. As newer detection and treatment options become available, the outlook for people with stage 4 bladder cancer is likely to improve.

If you or someone you know has stage 4 bladder cancer, it’s important to work with your doctor to find treatments that are right for you