Bladder Cancer Recurrent

Bladder cancer has one of the highest recurrence rates among all cancers, making ongoing surveillance essential even after successful treatment. Understanding why the cancer can return and what steps to take can help patients and their families navigate this challenging journey.

Table of contents

• What Is Recurrent Bladder Cancer?
• Why Does Bladder Cancer Recur?
• Who Is Most at Risk?
• How Often Does Bladder Cancer Recur?
• Why Early Detection of Recurrence Is Important
• Treatment Options for Recurrent Bladder Cancer
• The Importance of Surveillance and Monitoring
• Living After Bladder Cancer Treatment

What Is Recurrent Bladder Cancer?

Recurrent bladder cancer means that the cancer has come back after it has been treated^[1]. This is a common concern for people diagnosed with bladder cancer, as the disease has one of the highest rates of recurrence compared to other types of cancer. It is relatively common for people who are diagnosed with bladder cancer to experience a return of their cancer at least once following initial treatment^[1].

The way recurrent bladder cancer is treated depends on several factors. These include where the cancer comes back, what treatments you have already had, when it comes back after initial treatment, and the grade (a measure of how abnormal the cancer cells look under a microscope)^[2].

Why Does Bladder Cancer Recur?

Bladder cancer develops when cells in the bladder begin to grow, divide, and spread in an uncontrolled way, leading to the formation of a malignant tumor (a cancerous growth)^[1]. Although treatments can be very effective at removing tumors, a small number of cancerous cells can sometimes remain. Bladder cancer can recur when cancer cells left behind begin to grow again after treatment has finished^[1].

Sometimes patients who have been previously treated for bladder cancer can go on to develop a different type of cancer in the bladder or elsewhere in the body. This is known as a secondary cancer^[1].

Who Is Most at Risk?

A person’s individual risk for bladder cancer recurrence can depend on a number of different factors. These include the type and stage of cancer, success of initial treatment, and demographic and lifestyle factors such as age and smoking history^[1].

Researchers don’t yet understand all of the reasons why bladder cancer can recur, or who will definitely experience recurrence of their cancer^[1]. This is one of the reasons why physicians strongly recommend that people who have previously been diagnosed with bladder cancer have regular ongoing check-ups following treatment. This is sometimes called active surveillance^[1].

How Often Does Bladder Cancer Recur?

Recurrence rates for bladder cancer can be quite high compared to other types of cancer. Generally, over half of all people who develop bladder cancer may experience recurrence of their cancer following treatment^[1].

Non-Muscle Invasive Bladder Cancer Recurrence

Non-muscle invasive bladder cancer is the most common bladder cancer diagnosed. It is considered to be early-stage, as the cancer cells are present only in the inner lining of the bladder^[1]. Healthcare providers can treat early-stage bladder cancer, but about 75% of early-stage bladder cancers come back^[8].

Chances of recurrence can be very high for non-muscle invasive bladder cancer. Around 31% to 78% of people with this cancer will develop recurrence or a secondary bladder cancer within 5 years following treatment, depending on risk factors^[1]. In a study of individuals with high-grade non-muscle-invasive disease, 39.1% experienced recurrence^[6].

Treatment for non-invasive or non-muscle-invasive recurrence often depends on whether the recurrence happens soon after treatment or later. If the cancer comes back 6 to 12 months after treatment, it is called an early recurrence. If the cancer comes back 12 months or more after treatment, it is called a late recurrence^[2]. Non-invasive and non-muscle-invasive recurrences are treated the same as early stage bladder cancer^[2].

Muscle-Invasive Bladder Cancer Recurrence

Muscle invasive bladder cancer means the cancer has grown into the muscle layer of the bladder^[1]. This cancer is less commonly diagnosed, but can be more aggressive and have a high rate of recurrence and progression. Patients with muscle-invasive bladder cancer often need a more aggressive treatment regime, and chances of recurrence following treatment can still be around 30% to 54%^[1].

When Recurrence Can Happen

It can also be very difficult to predict when bladder cancer may recur. Bladder cancer can sometimes come back up to 5, 10, or even 15 years after treatment^[1]. This means that if you have been previously diagnosed with bladder cancer, you may be asked to undergo extra surveillance check-ups and monitoring for any recurrence for many years after initial treatment^[1].

Why Early Detection of Recurrence Is Important

Regular monitoring and surveillance following treatment is important for helping to detect bladder cancer recurrence early and ensuring the best chance of a good outcome for patients^[1]. Bladder cancer is usually treatable, especially when caught early^[1].

Because bladder cancer often comes back after surgery, most people receive intravesical chemotherapy (chemotherapy delivered directly into the bladder) with drugs like mitomycin or gemcitabine, or intravesical BCG at the time of their first surgery^[10]. This helps lower the risk of recurrence.

A study showed that flushing the bladder with the chemotherapy drug gemcitabine after tumors have been removed surgically may reduce the risk of the cancer returning. Among patients with low-grade bladder cancer, 34% of those receiving gemcitabine had a recurrence, compared with 54% of patients receiving placebo—a 37% relative reduction in the recurrence rate^[4].

Treatment Options for Recurrent Bladder Cancer

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan^[2].

Surgery for Muscle-Invasive or Locally Advanced Recurrence

Surgery may be used to treat muscle-invasive and locally advanced recurrences. It is usually done if you were treated with a bladder-preserving approach and the bladder wasn’t removed^[2].

A radical cystectomy removes the whole bladder and sometimes tissue and organs surrounding the bladder^[2]. Urinary diversion surgery is needed once the bladder is removed. A urinary diversion makes a new way to hold urine and pass it out of the body. It is done after a radical cystectomy^[2].

A pelvic lymph node dissection removes lymph nodes from the pelvis. It is done following a radical cystectomy, usually during the same surgery^[2].

A transurethral resection of bladder tumor (TURBT) removes tumors from the bladder through the urethra. It may be done to control symptoms when a cystectomy can’t be done^[2].

Chemotherapy

Chemotherapy is usually offered for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation (chemotherapy combined with radiation therapy) if radiation therapy wasn’t already used^[2].

If the cancer comes back more than 12 months after treatment, a combination of chemotherapy drugs that includes cisplatin is commonly used. If the cancer comes back within 12 months of treatment, immunotherapy is used instead^[2].

Radiation Therapy

You may be offered external radiation therapy for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation. External radiation therapy may also be used alone if surgery can’t be done^[2].

Immunotherapy

You may be offered immunotherapy for a locally advanced recurrence. An immune checkpoint inhibitor is an immunotherapy drug that may be used if the cancer comes back within 12 months of finishing chemotherapy that includes cisplatin^[2].

BCG was the first FDA-approved immunotherapy treatment for bladder cancer, approved in 1990^[13]. BCG helps reduce the risk of bladder cancer recurrence by stimulating an immune response that targets the bacteria as well as any nearby bladder cancer cells. Approximately 70% of bladder cancer patients go into remission after BCG therapy^[13].

The Importance of Surveillance and Monitoring

It’s common for bladder cancer to come back, even after successful treatment. As a result, it is important for people who have been treated for bladder cancer to visit their doctor regularly to get certain follow-up exams or tests^[19].

This can be hard for a number of reasons. Planning and scheduling these appointments can be stressful and time-consuming. Waiting for test results can cause anxiety and an ongoing fear of recurrence. The added costs of things such as copays, medicines, and parking and transportation fees only add to the stress^[19].

Because their disease is likely to recur, patients with bladder cancer must undergo surveillance for an extended period^[13]. Procedures used during bladder cancer monitoring and surveillance may include examinations with a camera inserted through the urethra to view the bladder, as well as urine tests and imaging studies.

Living After Bladder Cancer Treatment

Completing your treatment and pushing bladder cancer back into remission is a reason to celebrate. However, as many survivors know, cancer does not end after treatment^[16]. Evidence suggests non-muscle invasive bladder cancers (making up approximately 70% of those diagnosed) have a high recurrence rate—up to 70% within two years of treatment—so it’s normal to have concerns and ask questions^[16].

Taking Care of Your Bladder

After bladder cancer treatment, you can take steps to help protect your bladder from recurrence^[16]:

• Quit smoking: Smoking is thought to be the cause of about half of all bladder cancers^[16]. Although quitting can be tough, it will help you feel healthier overall and less anxious about cancer.
• Stay hydrated: Drinking lots of fluids, particularly water, may lower your risk of developing bladder cancer. Try to drink six to eight glasses of water a day^[16].
• Get your fruits and vegetables: A diet high in fruits and vegetables may help keep your bladder healthy^[16]. Aim to have at least five servings of fruits and vegetables every day.
• Exercise: Regular exercise helps reduce the risk of recurrence and can add more years to your life. Only 30 minutes a day of moderate exercise reduces anxiety and symptoms such as fatigue, nausea and pain^[16].

Overcoming Fear

Cancer is a life-changing experience, and fear that the cancer will come back is one of the most common concerns experienced by survivors^[16]. In this respect, time heals, and many cancer survivors report thinking about the disease less often as the years go by.

Tips to help you gain control of your fear include acknowledging your fears by writing them down, learning as much as you can about bladder cancer, expressing yourself to friends or family members or in writing, and finding ways to relax^[16].

Managing Fatigue

Body changes may affect your self-image and daily life after treatment. Having a stoma and urostomy bag takes time to get used to. Some people need to learn how to use a catheter to empty their bladder, which is another big change^[19]. Adjusting to these changes can be hard, but over time many people are able to do a lot of what they did before surgery. Support from family members and your health care team can help you get used to life after urostomy surgery^[19].

Emotional and Practical Support

When you first learn that you have bladder cancer or that it has returned, you may wonder how you’re going to cope with the upcoming changes in your life. One step you can take is to be informed of the physical and emotional changes that may occur and what resources are available to help you^[19]. Talking with your health care team about your concerns can give you a greater sense of control. Family and friends can also be important sources of support^[19].