Muscle invasive bladder cancer staging

Muscle invasive bladder cancer has spread into or through the muscle layer of the bladder. To describe some muscle invasive bladder cancer, doctors might also use the terms:

  • locally advanced bladder cancer
  • metastatic or advanced bladder cancer

Muscle invasive bladder cancer is different to non muscle invasive bladder cancer. In non muscle invasive bladder cancer, the cancer cells are only in the inner lining. They haven’t spread into the muscle layer of the bladder wall.

The stages of muscle invasive bladder cancer

Your doctor looks at how far cancer tumours have grown into the bladder. This is called the T stage (T stands for tumour). There are three T stages of muscle invasive bladder cancer:

  • T2 means cancer has grown into the muscle layer of the bladder 
  • T3 means cancer has grown through the muscle layer into the fatty tissue layer
  • T4 means cancer has grown outside the bladder OR into the prostate, womb or vagina, OR into the wall of the pelvis (the area between the hip bones) or tummy (abdomen)
Diagram showing muscle invasive bladder cancer

Your doctor also looks at:

  • whether cancer has spread to any lymph nodes (this is called the N stage)
  • whether or not it has spread (metastasised) to other parts of the body (distant metastasis) like the bones, lungs or liver (this is called the M stage)

Locally advanced bladder cancer

Locally advanced bladder cancer means your cancer has spread:

  • through the bladder and into the nearby tissues including the vagina, womb, ovaries, prostate, and back passage
  • into nearby lymph nodes
Diagram showing stage N1 bladder cancer

Advanced (metastatic) bladder cancer

Advanced bladder cancer means that your cancer has spread to:

  • the wall of the tummy (abdomen) or between the hips (pelvis)
  • distant lymph nodes
  • other parts of the body such as the bones, lungs or liver

It is also called metastatic bladder cancer.

Diagram showing metastatic bladder cancer


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions

Treatment may include:

  • surgery
  • chemotherapy
  • radiotherapy
  • radiotherapy with chemotherapy (chemoradiotherapy)
  • AJCC Cancer Staging Manual (8th Edition)
    S Edge and others
    Springer, 2017

  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015


    Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.
    T Powles and others
    Annals of oncology, 2022 Volume 33, Issue 3, Page 244 - 258


  • EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
    JA Witjes and others
    European Association of Urology, 2022

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
28 Sep 2022
Next review due: 
28 Sep 2025

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