These cancers have reached the abdominal or pelvic or abdominal wall (represented as T4b). They may have spread to nearby lymph nodes (any N), and have spread to distant parts of the body (M1). Stage IV cancers are not curable.
Chemotherapy (with or without radiation) is usually the first treatment if the cancer has not spread to distant parts of the body (M0). The tumor is then reexamined. If it appears to be gone, chemotherapy with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder cystectomy may be recommended.
Chemotherapy with or without radiation is the first treatment when bladder cancer has spread to distant parts of the body (M1). After this treatment the cancer is reexamined. If it looks like it is gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, chemotherapy, radiation, both at the same time, and immunotherapy might be options.
In most cases surgery or radical cystectomy cannot remove all of the cancer, so treatment is usually aimed at slowing the tumor growth and spread to help people live longer and feel better. If surgery is a treatment option, it is important to understand the goal of the operation – is it to try to cure the cancer, help a person live longer, or help prevent or relieve symptoms from the bladder cancer.
People who cannot take chemotherapy because of other health problems might be treated with radiation therapy or with an immunotherapy drug. Urinary diversion without cystectomy is sometimes done to prevent or relieve a blockage of urine that could cause severe kidney damage. Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial. Read more about other treatment options for bladder cancer.