Recurrent bladder cancer

Recurrent bladder cancer is bladder cancer that comes back after treatment.

The recurrence rate of bladder cancer is high. Many people with bladder cancer will have cancer return after treatment. The chances of having a recurrence may vary depending on the original cancer's size and stage.

When bladder cancer comes back, it most often happens in the first two years after treatment. But it also can happen many years later. Bladder cancer can recur in the bladder. In those who had surgery to remove the bladder, the cancer might come back in the area where the bladder used to be. Bladder cancer also can come back in other parts of the body.

When the cancer comes back in the bladder, it often can be removed completely. When the cancer comes back in other areas, a cure may not be possible. In this case, treatment can slow the growth of the cancer and extend your life. Newer treatments and more personalized treatment approaches are helping many people live longer with recurrent bladder cancer.

The signs and symptoms of recurrent bladder cancer may depend on where the cancer comes back. This cancer is often detected during a follow-up exam to look for recurrence.

When bladder cancer comes back in the bladder, symptoms may include:

• Blood in the urine, called hematuria. The blood may turn urine red or brown.
• Urinating more often than usual.
• Feeling an urgent need to urinate.
• Pain or burning with urination.

When bladder cancer comes back in distant parts of the body, symptoms may include:

• Fatigue.
• Headaches and changes in thinking and memory.
• Losing weight without trying.
• Pain in a bone.
• Pain in the upper right part of the belly.
• Swollen feet.

When to seek care

After your bladder cancer treatment ends, your care team may create a schedule of follow-up exams for you. These exams check for signs of cancer recurrence.

You also can report any new symptoms to your healthcare professional. Make an appointment with your healthcare professional if you have any symptoms that worry you.

It's not clear what causes bladder cancer recurrence. Bladder cancer usually starts as a growth of cells on the inside lining of the bladder. When it comes back in the bladder, it often starts the same way. Scientists don't fully understand why this happens. It's possible that some cancer cells may remain after treatment. The cells may form a new growth in the bladder. Another theory is that the same harmful substances that caused the first cancer also affected other cells in the bladder lining. These other cells could become cancerous later.

Sometimes the bladder cancer comes back in other parts of the body. This could happen if cells break away from the cancer in the bladder. They can spread through the lymphatic system or blood. This kind of recurrence might happen if the cancer cells have already started to spread at the time of the first diagnosis. The cells may have hidden in another part of the body where they weren't detected. Later, these cells begin growing again. When bladder cancer spreads, it's called metastatic bladder cancer.

The risk of recurrent bladder cancer may depend on the features of the original cancer. Factors that may raise the risk include:

• The cancer's stage. The stage tells the healthcare team about how far the cancer has grown into the bladder. Having a cancer that grows into or through the muscle layer of the bladder raises the risk of recurrence. There is a lower risk if the cancer affects only the inner lining of the bladder.
• The cancer's grade. The grade describes how the cancer cells look compared to healthy cells. If the cancer cells look similar to healthy cells, the cancer is low grade. If the cancer cells look very different from healthy cells, then the cancer is high grade. High-grade bladder cancers are more likely to recur than low-grade cancers.
• The cancer's size. If the cancer in the bladder is larger than 3 centimeters (about 1.2 inches), the risk of recurrence is increased. Having a smaller area of cancer may mean a lower risk.
• Having more than one area of cancer in the bladder. Having multiple growths of cancer in the bladder raises the risk of recurrence.
• Having cancer in the nearby lymph nodes. If the first bladder cancer diagnosis found cancer in the lymph nodes, there is a higher risk of recurrence.

There's no sure way to prevent recurrent bladder cancer, but some treatments and lifestyle changes may help lower the risk that the cancer will come back.

Treatments to lower the risk of recurrence

Sometimes medicines and radiation therapy are used to lower the risk of a bladder cancer recurrence. After a procedure to remove the cancer, your healthcare team might recommend medicines, such as chemotherapy or immunotherapy, or radiation therapy. Talk with your healthcare team about your risk of bladder cancer recurrence and whether these treatments may help lower the risk.

Self-care to lower the risk of recurrence

After bladder cancer treatment, healthcare professionals generally recommend making healthy choices that support overall health. These measures also might help lower the risk of cancer recurrence.

Try to:

• Follow a healthy diet. Choose a diet that's rich in fruits, vegetables and whole grains. Avoid foods with high levels of fat and cholesterol. Some evidence shows cruciferous vegetables, such as broccoli, cabbage, collard greens and kale, may lower the risk of recurrence. If you enjoy eating these vegetables, consider adding more of them to your diet.
• Stay active. Aim to exercise most days of the week. If you don't exercise regularly, talk with your care team before you start. Begin with short sessions of an activity you enjoy and build up the amount of exercise over time.
• Strive for a healthy weight. Ask your healthcare professional what weight is healthy for you. If you are at a healthy weight, work to maintain it. If your care team recommends weight loss, aim to lose weight slowly. Start by making healthy choices, such as eating fewer calories, moving more and sitting less.
• Stop smoking. If you smoke, ask your healthcare team about what might help you quit. It can be very hard to quit smoking on your own, so ask your healthcare team for help.

Tests to catch a recurrence early

After treatment for bladder cancer, healthcare professionals often recommend follow-up tests to check for recurrence. If your bladder wasn't removed to treat your cancer, follow-up testing may involve cystoscopy exams to look inside the bladder for signs of cancer. For those who had bladder removal surgery, follow-up testing may involve imaging tests to look at the urinary tract. These tests don't prevent recurrence, but they may help find recurrent cancer when it is small and more likely to be treated successfully.

Recurrent bladder cancer often is found during follow-up tests after treatment. Sometimes symptoms lead to tests that find the cancer. Your healthcare professional may recommend more tests to confirm that the cancer has come back.

If your bladder wasn't removed during treatment, your healthcare professional might do a cystoscopy exam to look inside the bladder for signs of cancer. If your bladder was removed, imaging tests might be used to look for cancer in the urinary tract or other parts of the body. Your healthcare team also may remove a tissue sample for testing.

Cystoscopy

Cystoscopy is a procedure that lets a healthcare professional see inside the bladder. During cystoscopy, a healthcare professional puts a small, narrow tube, called a cystoscope, through the urethra. The urethra is the tube that takes urine from the bladder out of the body. The cystoscope has a lens the healthcare professional uses to see inside the urethra and bladder to check for signs of disease.

Imaging tests

Imaging tests make pictures that the healthcare team uses to look for signs of cancer. The tests may make pictures of the urinary tract or other parts of the body.

Tests that look for cancer in the urinary tract include:

• CT urogram. During a CT urogram, a contrast material is put into a vein in the hand. The contrast flows into the kidneys, ureters and bladder. X-ray images taken during the test show a detailed view of the urinary tract. Those images help the healthcare team see any areas that might be cancer.
• Retrograde pyelogram. A retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, a thin tube, called a catheter, is put through the urethra and into the bladder. Contrast material then is put into the catheter and flows into the ureters and kidneys while X-ray images are taken of these areas.

Tests that look for cancer in other parts of the body include:

• Bone scan. A bone scan uses nuclear imaging to make pictures. Nuclear imaging involves using small amounts of radioactive substances, called radioactive tracers. A special camera that can detect the tracers also is used along with a computer.
• Computerized tomography (CT) scan. A CT scan is a type of imaging that uses X-ray techniques to create detailed images of the body. Then a computer creates cross-sectional images, also called slices, of the bones and soft tissues inside the body.
• Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create pictures of the inside of the body.
• Positron emission tomography (PET) scan. A PET scan is a nuclear imaging test. It uses a radioactive tracer that's put into a vein. The tracer contains a substance that helps it stick to the cells that the test is looking for. The PET images show the places where the tracer builds up.

Not everyone needs every test. Your healthcare team chooses the imaging tests based on your symptoms and your situation.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. If your bladder wasn't removed during previous cancer treatment, a healthcare professional may get a tissue sample during a cystoscopy exam. The healthcare professional may pass a tool through the scope and into the bladder to do a biopsy.

If your bladder was removed to treat a previous cancer or if the cancer spreads to other parts of the body, the healthcare professional may get the tissue sample in a different way. How the healthcare professional does this depends on where the cancer is in your body.

Tests in the lab can confirm that the cancer is a bladder cancer recurrence. Tests also can look at the DNA changes that are present in the cancer cells. The results may help your healthcare team understand your prognosis and make a treatment plan.

Transurethral resection of bladder tumor

Transurethral resection of bladder tumor (TURBT) is a procedure to diagnose bladder cancer and to remove small cancers from the inside of the bladder. During the procedure, a healthcare professional passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Sometimes a high-energy laser may be used instead of the electric wire loop.

If your bladder wasn't removed, TURBT might be part of your diagnosis. If the cancer affects only the inside lining of the bladder, TURBT also might help treat the cancer.

Treatments for recurrent bladder cancer include procedures to remove the cancer, including surgery to remove the bladder, medicines and radiation therapy. Medicines to treat recurrent bladder cancer include chemotherapy, immunotherapy and others.

The treatments that your healthcare team recommends may depend on where the cancer comes back. When cancer comes back in the bladder, treatment usually involves removing the cancer. The type of procedure the healthcare team recommends may depend on whether the cancer has grown into the bladder wall or whether it has a high risk of growing into it.

When cancer comes back in places other than the bladder, treatment often starts with medicines. How well the medicines work might help your care team decide what other treatments to consider.

When making your treatment plan, your care team also thinks about your preferences and your goals for treatment.

Treatment for cancer recurrence in the bladder

If bladder cancer comes back in the bladder, treatment usually starts with a procedure to remove the cancer.

TURBT with intravesical medicines. Transurethral resection of bladder tumor (TURBT) is a procedure to remove cancer that affects the inner layers of the bladder only. During the procedure, a healthcare professional passes tools through a cystoscope and into the bladder. The tools are used to remove the cancer.

After TURBT, your healthcare team may recommend having medicines put into the bladder. Giving medicines this way is called intravesical therapy. Which medicines you get may depend on your situation and whether you had this treatment in the past.

TURBT with intravesical medicines may be used to treat recurrent bladder cancer that affects only the inner lining of the bladder. This is called non-muscle-invasive bladder cancer.

Bladder removal surgery. Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, a surgeon takes out only the area of the bladder that has the cancer.

During a radical cystectomy, a surgeon takes out all of the bladder and the lymph nodes around it. Radical cystectomy typically also includes removal of the prostate gland and seminal vesicles or the uterus, ovaries and part of the vagina. The surgeon then creates a way for urine to leave your body, called a urinary diversion.

Medicines, such as chemotherapy and immunotherapy, may be used before or after surgery. Radiation therapy also may be used.

Bladder removal surgery might be used when the recurrent bladder cancer grows into the wall of the bladder. This is called muscle-invasive bladder cancer. Cystectomy also may be used if the cancer comes back after previous bladder preservation therapy.

Cystectomy is sometimes used to treat non-muscle-invasive bladder cancer. It might be used if the cancer has a high risk of becoming invasive or if it comes back soon after treatment.

Bladder preservation. Sometimes, people with bladder cancer that has gone into the bladder's muscle layer don't want to have the bladder removed. In that situation, the healthcare team may use a combination of treatments instead. Called trimodality therapy, this approach uses TURBT, chemotherapy and radiation therapy.

First, a surgeon uses TURBT to take out as much of the cancer as possible while keeping bladder function. Then, after the surgery, chemotherapy is given along with radiation therapy. If any cancer remains after trimodality therapy, a radical cystectomy may be needed.

Bladder preservation may be an option for those who prefer not to have bladder removal surgery or for whom surgery isn't recommended.

Treatment for cancer that comes back outside of the bladder

When bladder cancer comes back in places other than the bladder, treatment may start with medicines.

• Chemotherapy. Chemotherapy treats cancer with strong medicines.
• Immunotherapy. Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
• Antibody-drug conjugates. Antibody-drug conjugates are medicines that combine targeted therapy with chemotherapy. These medicines use targeted therapy to identify the cancer cells and deliver chemotherapy directly to those cells.
• Targeted therapy. Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Which medicines you get may depend on your cancer, your overall health and which treatments you've had in the past. If the medicines work well to control the cancer, other treatments, such as surgery or radiation therapy, may be used to treat the remaining cancer.

Finding out your bladder cancer has returned can be more upsetting than your first diagnosis. As you sort through your emotions and make decisions about treatment, here are some ideas that may help you cope.

Learn more about recurrent bladder cancer

Ask your healthcare professional about your cancer, including your treatment options and, if you like, your outlook. As you learn more about recurrent bladder cancer, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong may help you deal with your recurrent bladder cancer. Friends, family and other people you trust can provide the practical support you may need, such as helping take care of household tasks if you're in the hospital. And they may serve as emotional support when you feel overwhelmed by cancer.

Find someone to talk with

Find a good listener who you can talk with about your hopes and fears. This may be a friend or family member. You also may find it helpful to talk with a counselor, medical social worker or clergy member. Or join a cancer support group for understanding and guidance.

Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Make an appointment with a healthcare professional if you have any symptoms that worry you. If your healthcare team suspects you might have recurrent bladder cancer, you might be referred to a doctor who specializes in treating diseases and conditions of the urinary tract, called a urologist. Or you may be referred to a doctor who treats cancer, called an oncologist. Here are some things you can do to get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before your appointment, such as not eating or drinking for a certain amount of time. Make a list of:

• Your symptoms, including any that don't seem related to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take, including the doses.
• Questions to ask your healthcare professional.

Take a family member, friend or another trusted person with you, if possible, to help you remember the information you're given.

For recurrent bladder cancer, basic questions to ask your healthcare professional include:

• Do I have recurrent bladder cancer, or could my symptoms be caused by another condition?
• What tests do I need?
• What are my treatment options?
• Can any treatments cure my bladder cancer?
• What are the possible risks of each treatment?
• Should I see a specialist?
• Do I need follow-up appointments?
• Are there brochures or other printed materials that I can take with me? What websites do you recommend?

Be sure to ask any other questions you may have.

What to expect from your care team

Your healthcare professional may ask:

• When did your symptoms start?
• Are your symptoms always present, or do they come and go?
• How bad are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?