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Muscle Invasive Bladder Cancer

Muscle invasive bladder cancer (MIBC) is a more advanced stage of bladder cancer, where tumours have grown into or through the deep muscle wall of the bladder — unlike non-muscle invasive bladder cancer (NMIBC), where tumours remain confined to the bladder’s inner lining. Because the cancer has reached the muscle layer, MIBC carries a higher risk of spreading beyond the bladder. Understanding the symptoms, diagnosis, and treatment options is crucial for managing the disease effectively.

For a general overview of bladder cancer, including risk factors and early detection, visit our Understanding Bladder Cancer page.

What is Muscle Invasive Bladder Cancer (MIBC)?

Bladder cancer is most often found in the urothelial or transitional cells that line the inside of the bladder. When tumours grow into or through the muscle wall of the bladder, it is known as muscle invasive bladder cancer (MIBC). When bladder tumours spread into the bladder muscle, they are more likely to spread further and be more life threatening.

Muscle invasive bladder cancer occurs in approximately 25% of bladder cancer cases.
The most common symptom of MIBC is blood in the urine (hematuria). Other symptoms can include pain, urgency, or frequency when urinating. Visit our Symptoms and Diagnosis page for a full breakdown of warning signs and when to see a doctor.
Muscle invasive bladder cancer is diagnosed by urine and blood tests, CT scan and by looking inside the bladder (cystoscopy).
Treatment options for muscle invasive bladder cancer include surgery (the most common), chemotherapy and immunotherapy.

Doctors also assign a T stage (T2, T3, or T4) to describe how far the cancer has grown beyond the muscle wall, which helps guide treatment planning. Learn more on our Staging and Grading page.

Considerations for Managing Muscle Invasive Bladder Cancer (MIBC)

The ideal MIBC treatment is to remove the cancer as completely as possible to prevent it from spreading. In most cases, this type of cancer is treated through surgery to remove the bladder completely, called a radical cystectomy, and create a new path for urine to leave the body.

Depending on the health of the patient, chemotherapy is used before surgery, referred to as neoadjuvant chemotherapy, to help remove any cancer cells that may have progressed to outside the bladder. Chemotherapy after surgery is referred to as adjuvant chemotherapy.

Treatment may also be used to avoid surgery to keep the bladder. If you’re older, your urologist may feel that surgery is too risky, you may have other health issues that increase the risk from surgery, or you may have personal reasons for not wanting this major surgery.

Muscle Invasive Bladder Cancer Treatment and Management

There is a risk of recurrence with this type of bladder cancer depending on how quickly the cancer is diagnosed, the extent of the cancer, and the treatment used. There are several treatment options available:

Radical Cystectomy (Complete Bladder Removal Surgery)

Bladder removal, also known as a radical cystectomy, is a common treatment for MIBC. There are several choices for diverting urine once the bladder is removed:

A neobladder is a reservoir made of small intestine, constructed in the same location as the original bladder and connected to the patient’s urethra.
An Indiana pouch uses a section of large intestine to build a reservoir that stores urine, which is accessed through a small opening in a patient’s skin (stoma). With this type of urinary diversion, the patient inserts a catheter into the new pouch through this opening to drain urine.
With an ileal conduit a surgeon creates a small opening in a patient’s skin (stoma) on the right lower abdomen, from which urine drains into a bag. The bag is worn underneath the clothes and usually cannot be seen.

For more information, visit our Radical Cystectomy information webpage.

Bladder Preservation (Tri-Modality Therapy – TMT)

Bladder Preservation is an option for some patients, which is usually a combination of three treatments for bladder cancer – radiation therapy, chemotherapy and resection of the tumour. The combination of these three treatments is called Tri-modality Therapy (TMT) or Modern Combined-Modality Therapy (CMT).

Immunotherapy

Muscle invasive bladder cancer patients receive immune checkpoint inhibitors and/or chemotherapy, which in turn activates the body’s immune system. Activated immune cells then attack and destroy cancer cells.

Note: Bacillus Calmette-Guérin (BCG treatment) is an intravesical treatment that is used to treat non-muscle invasive bladder cancer (NMIBC). It is not used to treat muscle invasive bladder cancer (MIBC).

Resources and Support for Muscle Invasive Bladder Cancer Patients

Bladder Cancer Canada has produced a helpful Guidebook with information about muscle invasive bladder cancer, how it’s diagnosed and the treatment options available. You can download a free copy of our Guidebook. We also host a moderated public Discussion Forum where you can ask questions, share your experiences and read about the experiences of others.

The Canadian Urological Association establishes guidelines providing evidence-based guidance for healthcare clinicians based on best practices. To review the guidelines regarding muscle invasive bladder cancer, please click here.

We encourage you to contact Bladder Cancer Canada for support if you have muscle invasive bladder cancer by email or by calling 1-866-674-8889.