Bladder cancer

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Treatments for stage 4 bladder cancer

The following are treatment options for stage 4 bladder cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.


In most cases, a radical cystectomy and a urinary diversion may be done for stage 4 bladder cancer.

Radical cystectomy

A radical cystectomy removes all of the bladder along with surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed. In men, the prostate gland, seminal vesicles and part of the urethra may be removed. In women, the uterus, cervix, fallopian tubes, ovaries, front wall of the vagina and urethra may be removed.

A radical cystectomy may be an option if the cancer has spread only to the pelvic organs and regional lymph nodes. In these cases, chemotherapy is usually given first (called neoadjuvant chemotherapy).

If the tumour has grown into the pelvic wall, it is usually considered inoperable. A radical cystectomy is not done unless chemotherapy can shrink the tumour.

A radical cystectomy is almost never done in people with metastatic bladder cancer. It may be done in rare cases to relieve symptoms and improve quality of life (called palliative surgery).

Urinary diversion

A urinary diversion creates a new pathway for urine to leave the body. If the bladder is removed, the surgeon needs to create a new pouch to hold urine and a new way for urine to leave the body.

A urinary diversion may also be done to relieve a blockage caused by the tumour and to maintain good kidney function. It may also be done to relieve symptoms and improve quality of life (called palliative therapy).


Chemotherapy is often offered to treat stage 4 bladder cancer and to improve survival. The most common chemotherapy drug combinations used for stage 4 bladder cancer are:

  • GemCIS, or GC – gemcitabine (Gemzar) and cisplatin (Platinol AQ)
  • MVAC – methotrexate, vinblastine (Velbe), doxorubicin (Adriamycin) and cisplatin
  • CMV – cisplatin, methotrexate and vinblastine

Radiation therapy

External beam radiation therapy may be used to treat stage 4 bladder cancer. It may be given to people who do not want, or cannot have, surgery. Radiation works better when it is given along with chemotherapy, but some people will not cope well with the side effects of chemotherapy due to other medical conditions or their age. For these people, radiation is given alone. Common chemotherapy drugs given with radiation are:

  • cisplatin
  • 5-fluorouracil (Adrucil, 5-FU) and mitomycin (Mutamycin)

Radiation therapy may also be given along with chemotherapy after the tumour has been completely removed with a transurethral resection, or TUR. This is called trimodal therapy because 3 treatments are given.

A TUR would not be offered alone to treat stage 4 bladder cancer. It uses a special instrument passed through a cystoscope to remove the tumour and a margin of healthy tissue around it. The surgeon then burns the area from where the tumour was removed with a high-energy electric current (called fulguration) or a laser. This procedure seals off blood vessels and destroys any remaining cancer.

A TUR may be used as part of trimodal therapy with radiation and chemotherapy as an alternative to surgery for some people who have only one tumour less than 5 cm, no blockage of the ureters, and normal bladder capacity and function.


Immunotherapy may be offered for stage 4 bladder cancer as a second-line therapy if the cancer is still growing during or just after finishing chemotherapy with cisplatin.

The immunotherapy drugs that may be used are pembrolizumab (Keytruda) or durvalumab (Imfinzi).

Clinical trials

You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.

second-line therapy

Treatment given for a condition or disease (such as cancer) when the first-line therapy (the first or standard treatment) does not work or stops working.

Also called secondary therapy or secondary treatment.


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