Here the bladder cancer may have metastasized the outside of the bladder (T3) and might have grown into nearby tissues or organs (T4) and lymph nodes (N1, N2, or N3). They have not spread to distant parts of the body.
Transurethral resection (TURBT) is commonly conducted first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy (or removal of the bladder and nearby lymph nodes) is then the standard treatment. Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy for bladder cancer prior to surgery with or without radiation has been successful in shrinking the tumor, which may make surgery easier. Chemotherapy can also kill any cancer cells that could already have spread to other areas of the body and aid in survival rate of the patient. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemotherapy is administered first, surgery to remove the bladder is delayed. The delay is not a problem if the chemotherapy shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemotherapy shrinks the tumor enough that intravesical therapy or chemo-radiation is possible instead of surgery.
Some patients are advised chemotherapy after surgery to kill any cancer cells left. Chemotherapy given after cystectomy may help patients stay cancer-free for longer, but so far it is not clear if it helps them live longer. If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemotherapy provided if it was not given before surgery.
An option for some patients with single, small tumors (some T3) might be treatment with a second (and more extensive) transurethral resection (TURBT) followed by a combination of chemo and radiation. If cancer is still found when cystoscopy is repeated, cystectomy might be needed.
For patients who are not healthy enough for surgery because of other serious health problems, treatment options might include TURBT, intravesical therapy, radiation, chemotherapy, immunotherapy, or a specific combination of these.