Recurrent bladder cancer

Descripción general

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.

Síntomas

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.

Causas

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.

Factores de riesgo

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.

Prevención

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.