Metastatic (stage 4) bladder cancer

Learn about metastatic bladder cancer, where it can spread and the symptoms it may cause. Explore treatments for advanced and stage 4 bladder cancer.

Update Date: 11.09.2026

Overview
Symptoms
Causes
Risk factors
Diagnosis
Treatment
Coping and support
Preparing for an appointment

Overview

Metastatic bladder cancer is cancer that starts in the bladder and spreads to other parts of the body. It is a type of stage 4 bladder cancer and often is described as an advanced bladder cancer.

Bladder cancer starts when cells in the bladder grow out of control. The cancer often starts on the inner lining of the bladder and may grow into the layers of the bladder wall. As the cancer becomes more advanced, it may grow through the bladder wall into nearby tissues or organs. Sometimes cancer cells break away and spread through the lymphatic system or enter the bloodstream. When bladder cancer spreads to distant parts of the body, it's called metastatic bladder cancer. It can spread to the lymph nodes, bones, brain, liver and lungs.

Some people have metastatic cancer when they're first diagnosed. More often, the cancer spreads after treatment for a previous bladder cancer. For many people, a diagnosis of metastatic cancer also is a recurrence of bladder cancer.

Treatment for metastatic bladder cancer usually starts with medicines, such as immunotherapy or chemotherapy. Treatments typically can't cure metastatic bladder cancer. But they may help slow the growth of the cancer and help with symptoms. Your healthcare team has many options to help you live as well as possible for as long as possible with advanced metastatic bladder cancer.

Symptoms

Metastatic bladder cancer signs and symptoms include:

  • An area of swelling or a growth in the belly that you can feel through the skin.
  • Pain in the back, pelvis or rectum.
  • Fatigue.
  • Loss of appetite.
  • Swollen feet.
  • Swollen lymph nodes.
  • Weight loss without trying.

If your bladder cancer has spread when it's first diagnosed, you also may have symptoms of cancer in the bladder. These may include blood in the urine, urinating more than usual and pain when urinating.

Metastatic bladder cancer may cause other symptoms, depending on where it spreads.

  • Cancer that spreads to the liver, called liver metastasis, may cause pain in the upper right part of the belly.
  • Cancer that spreads to the bones, called bone metastasis, may cause bone pain.
  • Cancer that spreads to the brain, called brain metastasis, may cause headaches and changes in thinking and memory.

When to seek care

Make an appointment with a healthcare professional if you have any symptoms that worry you. If you've been treated for bladder cancer in the past, tell the healthcare professional about your diagnosis and treatment.

Causes

It's not clear what causes metastatic bladder cancer. It happens when cancer cells in the bladder break away from the area where they formed. The cancer cells may spread through the lymphatic system or enter the bloodstream. This lets the cells travel to other parts of the body.

Bladder cancer can spread to the:

  • Bones.
  • Brain.
  • Liver.
  • Lungs.
  • Lymph nodes.

Risk factors

Factors that raise the risk of bladder cancer also may raise the risk of metastatic bladder cancer. These risk factors include:

  • Smoking. Smoking can raise the risk of bladder cancer by causing harmful chemicals to build up in the urine. These harmful chemicals may damage the lining of the bladder, raising the risk of cancer.
  • Increasing age. Bladder cancer can happen at any age, but it is more common in older adults.
  • Being male. Men are more likely than women to get bladder cancer.
  • Exposure to certain chemicals. Being around some types of chemicals often may raise the risk of bladder cancer. Those chemicals include arsenic and chemicals used to make dyes, rubber, leather, textiles and paint products.
  • Certain cancer treatments. Treatment for cancer with the medicine cyclophosphamide raises the risk of bladder cancer. People who have had radiation treatments aimed at the pelvis also have a higher risk of bladder cancer.
  • Bladder inflammation. Bladder inflammation, called cystitis, or a urinary tract infection that lasts or that keeps coming back may raise the risk of squamous cell bladder cancer. That could happen with long-term use of a urinary catheter. In some areas of the world, squamous cell carcinoma is linked to long-lasting bladder inflammation caused by a parasitic infection called schistosomiasis.
  • Personal or family history of cancer. If you've had bladder cancer before, you're more likely to get it again. If a blood relative, such as a parent, sibling or child, has had bladder cancer, you might have a higher risk of the disease too.

Diagnosis

To diagnose metastatic bladder cancer, a healthcare professional might start by asking about your symptoms and doing an exam. Metastatic bladder cancer is one type of stage 4 bladder cancer. It's often described as an advanced bladder cancer. Most people with this cancer were treated for bladder cancer in the past. So the health professional might ask about a previous cancer diagnosis and any treatments you had.

The tests you have may depend on your symptoms and your situation. Tests may include imaging tests and a biopsy procedure to remove some tissue for testing.

Imaging tests

Imaging tests make pictures of the inside of the body that the healthcare team uses to look for signs of cancer. For metastatic bladder cancer, imaging tests may show where the cancer has spread. Tests may include:

  • Bone scan. A bone scan uses nuclear imaging to make pictures. Nuclear imaging uses small amounts of radioactive substances, called radioactive tracers. A special camera that can detect the radioactivity is used along with a computer to make the images.
  • Computerized tomography (CT) scan. A CT scan is a type of imaging that uses X-ray techniques to create detailed images of the body. Then a computer creates cross-sectional images, also called slices, of the bones and soft tissues inside the body.
  • Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create pictures of the inside of the body.
  • Positron emission tomography (PET) scan. A PET scan is a nuclear imaging test. It uses a radioactive tracer that's injected into a vein. The tracer contains a substance that helps it stick to the cells that the test is looking for. The PET images show the places where the tracer builds up.

Not everyone needs every test. Your healthcare team chooses the imaging tests based on your symptoms and your situation.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. How the healthcare team does the biopsy for metastatic bladder cancer may depend on where the cancer has spread.

The sample goes to a lab for testing. In the lab, healthcare professionals look at the cells to confirm that they are bladder cancer cells. Other tests might give more information about the cancer. The cells might be tested to find out which DNA changes are present. The results can help the care team choose a treatment.

Treatment

Treatment for metastatic bladder cancer usually starts with medicines. Options may include immunotherapy, antibody-drug conjugates, chemotherapy and targeted therapy. If the first medicines stop working, the healthcare team might adjust the medicines or use different medicines. Radiation therapy and surgery may be used in some situations.

Metastatic bladder cancer often can't be cured, but treatments may help slow its growth. New medicines are helping people with metastatic bladder cancer live longer.

Your care team recommends a treatment plan based on your cancer and your overall health. If you've had treatment for bladder cancer in the past, your plan also may depend on which treatments you've already had.

Your goals and priorities also help guide treatment decisions. Some people want treatment to help them live as long as possible, even if it causes more side effects. Others place greater importance on quality of life and limiting treatment side effects. Talk openly with your cancer care team and the people close to you about what matters most to you so that everyone understands the goals of your care.

Chemotherapy

Chemotherapy treats cancer with strong medicines. It may be the first treatment for metastatic bladder cancer. Or it might be used if other treatments aren't working.

Chemotherapy regimens for metastatic bladder cancer often involve cisplatin along with other medicines. The combination of medicines you get may depend on your cancer and your overall health.

Chemotherapy side effects depend on the medicines used. Side effects may include low blood cell counts, infections and mouth sores. Cisplatin also can affect the kidneys, hearing and nerves.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be the first treatment for metastatic bladder cancer. Or it might be used after chemotherapy. Sometimes immunotherapy is combined with antibody-drug conjugate medicines.

Immunotherapy can cause side effects when the activated immune system affects healthy organs. These effects can involve the skin, intestines, liver, lungs or hormone-producing glands. Some hormone-related side effects can be permanent.

Antibody-drug conjugates

Antibody-drug conjugates are medicines that combine targeted therapy with chemotherapy. These medicines use targeted therapy to identify the cancer cells and deliver chemotherapy directly to those cells.

For metastatic bladder cancer, antibody-drug conjugate medicines may be used with immunotherapy as the first treatment. Antibody-drug conjugates also may be used alone or with immunotherapy after other treatments. Side effects may include hair loss, rash, tiredness, and nerve damage in the fingers and toes.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

For metastatic bladder cancer, targeted therapy medicines might be an option when other treatments aren't working. Your healthcare team may test your cancer cells to see if targeted therapy is likely to work against your cancer.

Targeted therapy side effects may depend on the medicines used. Side effects can include mouth sores and weakness.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons and other sources. Radiation therapy for bladder cancer may help with symptoms caused by metastatic cancer, such as pain.

Radiation therapy also may be used after treatment with medicines. If one or a few areas of cancer remain after treatment with medicines, radiation may help treat them.

Surgery

Surgery to remove the cancer usually isn't used to treat metastatic bladder cancer. It's sometimes used when treatment with medicines works well. If only one or a few areas of cancer remain after treatment with medicine, surgery to remove the cancer might be an option.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This team can include doctors, nurses and other specially trained health professionals. Their goal is to improve the quality of life for you and the people who care about you.

Palliative care specialists work with you, your family and your healthcare team to help you feel better. They provide added support while you have cancer treatment. You can have palliative care at the same time as treatment for cancer, such as surgery, chemotherapy or radiation therapy.

When palliative care is used with other appropriate treatments, people with cancer may feel better and live longer.

Coping and support

Learning you have metastatic bladder cancer can feel overwhelming. It's common to have a range of feelings that may change from day to day, and it can take time to process everything. As you move forward, here are some ideas that might be helpful.

Learn enough to make decisions about your care

If you'd like to know more about your bladder cancer, ask your healthcare team for the details of your cancer. Ask for good sources of information where you can learn more about your treatment options.

Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some people don't want to know the details of their cancer. If this is how you feel, let your care team know that too.

Find a good listener

Finding someone who is willing to listen to you talk about your hopes and fears can be helpful as you manage a cancer diagnosis. This could be a friend or family member. A counselor, medical social worker or clergy member also may offer helpful guidance and care.

You may find it helpful and encouraging to talk to others who have been diagnosed with metastatic bladder cancer. Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Let friends and family help

Your friends, family or other people you trust can provide a crucial support network for you during your cancer treatment. As you begin telling people about your diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with. Examples include listening when you want to talk or helping you prepare meals.

Preparing for an appointment

Make an appointment with a healthcare professional if you have any symptoms that worry you. You're likely to start by seeing your primary healthcare professional. If your healthcare team suspects you might have metastatic bladder cancer, you might be referred to a doctor who specializes in treating diseases and conditions of the urinary tract, called a urologist. Or you may be referred to a doctor who treats cancer, called an oncologist. Here are some things you can do to get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before your appointment, such as not eating or drinking for a certain amount of time. Make a list of:

  • Your symptoms, including any that don't seem related to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medicines, vitamins and other supplements you take, including the doses.
  • Questions to ask your healthcare professional.

Take a family member, friend or another trusted person with you, if possible, to help you remember the information you're given.

For metastatic bladder cancer, basic questions to ask your healthcare professional include:

  • Do I have metastatic bladder cancer, or could my symptoms be caused by another condition?
  • What tests do I need?
  • What are my treatment options?
  • Can any treatments cure my bladder cancer?
  • What are the possible risks of each treatment?
  • Should I see a specialist?
  • Do I need follow-up appointments?
  • Are there brochures or other printed materials that I can take with me? What websites do you recommend?

Be sure to ask any other questions you may have.

What to expect from your care team

Your healthcare professional may ask:

  • When did your symptoms start?
  • Are your symptoms always present, or do they come and go?
  • How bad are your symptoms?
  • What, if anything, makes your symptoms better?
  • What, if anything, makes your symptoms worse?

© 2026 Mayo Foundation for Medical Education and Research. All rights reserved. Terms of Use