Muscle Invasive Bladder Cancer: Everything You Should Know

Written by Marijke Vroomen Durning, RN
Medically Reviewed by Nazia Q Bandukwala, DO on April 28, 2025
10 min read

Muscle invasive bladder cancer (MIBC) is an advanced stage of bladder cancer that happens when cancer cells have reached the bladder wall and beyond. MIBC occurs in about 30% of people with bladder cancer. 

About 70% of people diagnosed with bladder cancer have what is called non-muscle invasive cancer, or superficial bladder cancer. The cancer cells remain in the inner lining. 

Cancer cells grow when the DNA in your body’s cells begin to change and become abnormal. These are called mutations. As these mutated cells multiply, they form tumors that destroy healthy body tissue, and they eventually spread to other parts of your body. In the case of MIBC, the cancer cells grow in the bladder wall and then spread.

Some people have a higher risk of muscle invasive bladder cancer than others. These include those who:

  • Are born male
  • Are more than 55 years old
  • Smoke tobacco
  • Have chronic bladder inflammation, often from repeat or long-term urinary tract infections
  • Are exposed to certain types of chemicals, often at work. These include arsenic and chemicals related to producing dyes, rubber, paint products, and more.
  • Have had cancer before and were treated with cyclophosphamide or radiation aimed at the pelvis
  • Have a family history of bladder cancer or Lynch syndrome

"The symptoms of bladder cancer are blood in the urine and sometimes unexplained urinary symptoms, like pain and irritation without any documented infection or cause for it," says Armine K. Smith, MD, director of urologic oncology at the Kimmel Cancer Center at Sibley Memorial Hospital. Once the cancer becomes more advanced, there may be other signs and symptoms, like:

  • Not being able to urinate at all
  • Lower back pain, specific to one side
  • Loss of appetite
  • Unintentional weight loss
  • Swelling in your feet
  • Bone pain

Other than being unable to pee, these symptoms could be mistaken for other health problems, so it’s important to tell your doctor if you also have any problems with urinating or blood in your urine. 

Diagnosing muscle invasive bladder cancer means having to identify the cancer cells and how deeply they’ve gone into the bladder wall or beyond. The simplest test is a urine test, where your urine sample is sent to a laboratory to look for cancer cells or blood in the urine. If the urine test is negative, your doctor may still run other tests.

"We would usually do an imaging test and a cystoscopy, which is a look inside of the bladder with the telescope, or cystoscope, as we call it," says Smith, who's also an assistant clinical professor of urology at the Brady Urological Institute of Johns Hopkins University School of Medicine, in Washington, D.C. The imaging tests could be a computerized tomography (CT) urogram or a retrograde pyelogram, which allows the doctor to examine the kidneys, ureters, and bladder.

"When we see a tumor or something that could resemble a tumor, we take the patient into the operating room," Smith says. The patient then goes under anesthesia so the doctor can take a biopsy (piece of the tissue) and send the sample to a lab for testing or remove the abnormal area altogether. This procedure is sometimes referred to as transurethral resection of the bladder (TURBT), which can be used for diagnosis and treatment.

Along with the bladder testing, your doctor might refer you for other imaging tests to see how far the cancer might have spread. These include:

  • CT scans. This test is used to see if the cancer has spread outside of your bladder.
  • Magnetic resonance imaging (MRI). During an MRI, images of your bladder are taken, using radio waves, a magnet, and a computer.
  • Positron emission tomography (PET)
  • Bone scan. This test checks for signs that cancer has spread to your bones.
  • Chest X-ray. This test confirms whether the cancer has spread to your lungs.

"Grade and stage are two different things," Smith says. "Grade shows how aggressive the cells look under a microscope. The stage shows the depths of the penetration of the tumor." Doctors used to grade bladder cancer using 1, 2, and 3, with 1 being the lowest grade. Now, bladder cancer is graded at either low or high.

Typically, low-grade cancers don’t look too different from the normal cells, and they usually grow slowly. High-grade cancer cells look much more abnormal and are more aggressive. And it’s possible to have a mix of the two. "That used to be old grade 2, but now, since it doesn't exist anymore, they would call it a low grade with some high-graded features," Smith explains.

The stages of bladder cancer are from I to IV. and the staging is done by looking at:

  • How far the tumor has gone through the wall or other tissues
  • If it has spread to any lymph nodes
  • If it has spread to any other parts of the body, or metastasized 

This is why, if you’re reading your records, you may see a stage number, followed by the initials T (for tumor), N (for nodes), and M (for metastasized).

Stage I – The cancer is still limited to the bladder lining.

Stage II – The cancer has spread to the bladder’s muscle wall.

Stage III – The cancer has spread to the fatty tissue beyond the bladder muscle.

Stage IV – The cancer cells have spread beyond your bladder to other parts of your lymph nodes, bones, or organs.

For effective muscle invasive bladder cancer treatment, it’s vital that your cancer is staged properly, Smith says. 

Once you’ve been assigned a stage, treatment can begin. The more advanced the cancer, the more aggressive treatment is. Some treatments are done with surgery, or instead of surgery if that’s not an option. 

"Invasive bladder cancer requires a lot more of a radical approach [to treatment]," Smith says. 

Surgery

Cystectomy. A cystectomy involves removing your entire bladder and, if needed, nearby organs and lymph nodes that the cancer may have spread to. Men may have to have their prostate gland removed. Women may need to have a radical hysterectomy (removal of the ovaries, fallopian tubes, uterus, part of the cervix, and part of the vagina).

Partial cystectomy. About 5% people with bladder cancer are candidates for a partial cystectomy, or partial bladder removal instead of a total removal. For this, your surgeon would remove only the affected part of your bladder. 

Once your bladder is removed, the surgeon will create a "urinary diversion," a different way for your body to collect and get rid of urine. 

Urostomy. The most common surgery is to create a urostomy. This is similar to a colostomy but is for urine instead. The surgeon will make a stoma (an opening) in your belly area where the urine can exit after it’s been filtered by the kidneys. A bag is attached to the stoma to collect the urine. You empty it as needed.

There are two other options that don’t require a bag or pouch outside your body, but they aren’t suitable for everyone. This is a discussion you must have with your doctor – which procedure is best for you: the urostomy or one of the other options, which include:

Reservoir. To create a reservoir or pouch, your surgeon would take some of your bowel to make a pouch that stays inside your body. A small opening in your belly area that goes to the reservoir allows you to insert a catheter (tube) into the reservoir to drain it. Putting a catheter in yourself is called self-catheterization.

New bladder. To create a new bladder altogether, the surgeon also uses a piece of your bowel, but connects the tissue to the urethra, the tube that used to drain your bladder. You would still need to self-catheterize, but through your urethra.

Bladder preservation

If your doctor believes that you don’t need to have your bladder removed or you can’t have surgery because of your health, bladder preservation might be possible. Trimodality therapy, which is a combination of a TURBT procedure to remove the cancer while keeping your bladder functional, followed by chemotherapy and radiation therapy, may be an option.

"We used to be of the opinion that everybody who had an invasive bladder cancer had to lose their bladder. I feel like we've kind of moved away from it a little bit now, so we do a lot more bladder preservation," Smith says. "We're still trying to find who are the patients most suitable for bladder preservation. That's a question that we still don't know."

Chemotherapy

People with muscle invasive bladder cancer may need to have chemotherapy, either to shrink the tumor before surgery or instead of surgery if you can’t have it. Chemotherapy can be done two ways: intravesical, which is chemotherapy put right into the bladder, or systemic, medication that is intravenous (IV) or given by mouth (pills). Some people have radiation therapy at the same time.

Radiation

Radiation therapy aimed directly at the tumor might be recommended if surgery isn’t an option.

Immunotherapy

With immunotherapy, you get medications that use your immune system to target cancer cells that can be put directly into the bladder or by IV, like chemotherapy.

Targeted therapy

Targeted therapy is treatment that targets specific proteins in some cancer cells and stops them from growing. They are given like immunotherapy, by pill or IV.

Clinical trials for MIBC

Research advances more quickly in some types of cancer than others, and up until recently, advances in bladder cancer treatment have been slow, Smith says. "But about 15 years ago … we started seeing a lot more advances." Over the past five years there have been several breakthroughs through clinical trials that have changed treatment approaches. 

During clinical trials, medications and other treatments are given to patients, and researchers assess how well they work and if there are any safety issues. They’re usually run by academic centers. If you’re interested in taking part in a clinical trial, speak with your doctor to see if there are any you qualify for. 

If you want to do your own research, you can find a list of trials at ClinicalTrials.gov. 

Learning to live your life with cancer can be challenging, especially as some of the treatments can make you feel sick or can change your body permanently, like if you need a urostomy. 

"The biggest change we see is when the bladder is removed, because that permanently alters the urination," Smith says. If you have a urostomy, you have adjust to your new body image and get used to having a stoma and bag to catch the urine. If you have an internal bladder placed, you’ll have to learn how to manage it or how to use a catheter (a tube) to drain it. 

"Even if you keep your bladder, if part of it is removed, then you will likely have to go to the bathroom more often because your bladder capacity is smaller than it used to be," Smith says. While it can take time to get used to living with MIBC, people can usually go on to do their regular activities like traveling, playing sports, and doing yoga.

Working with a team including your doctor and other health care professionals (like counselors) can be a great resource and help improve your quality of life.

Muscle invasive bladder cancer affects about 30% of people with bladder cancer. Early signs of bladder cancer include problems or pain with peeing and blood in your urine. If the cancer has gotten worse, there could be other signs, like back pain and unintentional weight loss. It’s important to get an accurate staging of how far along the cancer has progressed so you can get the proper treatment.

Does insurance cover fulguration of the bladder? Fulguration of the bladder, a procedure that uses a special tool to remove abnormal bladder tissue, isn’t done for muscle invasive bladder cancer. It’s a treatment for early bladder cancer or after doing a biopsy. Most insurance does cover the treatment, but be sure to check your coverage before a procedure.

Can radiotherapy cure muscle invasive bladder cancer? Radiotherapy, often given along with chemotherapy, can destroy cancer cells that cause bladder cancer. This might get rid of the cancer, but it also might just shrink the tumors.

What’s the recurrence rate of muscle invasive bladder cancer? High-grade cancers have a higher risk of coming back, or recurring. For example, one study showed that patients who had a cystectomy had anywhere from 20% to 70% recurrence rate, with the higher rates among people whose cancer had spread to the lymph nodes.

Is muscle invasive bladder cancer rare? No, muscle invasive bladder cancer isn’t rare. About 30% of people diagnosed with bladder cancer have muscle invasive bladder cancer.

How aggressive is muscle invasive bladder cancer? How aggressive muscle invasive bladder cancer is depends on its grade. If you’ve been diagnosed with low-grade MIBC, this is not considered to be very aggressive in most cases. But high-grade MIBC is more aggressive.

What does muscle invasive bladder cancer feel like? If you have muscle invasive bladder cancer, how you feel depends on how far it has spread. You may have a hard time peeing and back pain. You could also start losing weight, have swollen feet, and have bone pain.