Bladder Cancer

Recurrence

Treatment of recurrence (when the tumour comes back)

Local recurrence

Local recurrence takes place in the soft tissue where the bladder has been before removal or at the site of the lymph nodes that were removed. This is due to the fact that even after removal of the local pelvic lymph nodes, some nodes are left in place. Most local recurrences appear within the first 2 years. Local recurrence after complete removal of the urinary bladder is associated with poor overall prognosis but can occasionally be treated (surgery, chemotherapy, targeted radiation therapy).

Distant recurrence

If the cancer recurs outside the pelvis, it is a distant recurrence. This type of recurrence is fairly common after bladder removal in patients with high risk of recurrence (larger tumours, positive resection margins, involvement of the removed lymph nodes). Distant recurrence happens mostly within the first 2 years after bladder removal. Sites of distant recurrences are lymph nodes, lungs, liver, and bones.

Distant recurrence can be treated only by chemotherapy. Single or very few metastases may be surgically removed in addition to systemic treatment (= chemotherapy).
Medical trials might be available for your situation. Ask your doctor about these options. 

FAQ – What is a positive resection margin?

Rim of tissue — called the surgical margin or margin of resection

The surgeon’s goal during surgery is to remove the cancer along with a rim of normal tissue around it. This is to ensure that all of the cancer has been removed.

During or after surgery, a pathologist examines this rim of tissue — called the surgical margin or margin of resection — to be sure it’s clear of any cancer cells. If cancer cells are present, this will influence decisions about treatments such as additional surgery and radiation.

Recurrence

After complete removal of the bladder, the cancer can recur in the urethra, ureters and pyelum (urothelial tract). Most recurrences of the urothelial tract happen within the first 3 years after the operation. This type of recurrence is relatively rare.

If possible, a local treatment should be chosen to eliminate the cancer, unless systemic disease is suspected. In that case, chemotherapy or palliation should be used.

In case of bladder preserving therapy and a superficial (non–muscle-invasive) recurrence, washing the bladder with drugs to prevent the growth or spread of cancer cells (instillation therapy) is advised.

Risk factors for recurrence in the urethra after removal of the bladder:

  • Prior superficial (non–muscle-invasive) bladder cancer
  • Multiple bladder tumours
  • Tumour involvement of the bladder neck (and/or the prostate in men)
  • An unused/residual urethra after incontinent urinary diversion
  • Local recurrence in the lower pelvis

Although routine removal of the urethra (urethrectomy) is considered overtreatment, monitoring of the urethra is indicated in men.

Risk factors for recurrence in the ureters after removal of the bladder:

  • Prior superficial (non–muscle-invasive) bladder cancer
  • Multiple bladder tumours
  • Tumour involvement at the opening (orifice) of the ureter
  • Local recurrence in the pelvis

For patients with risk factors for urothelial recurrences, stringent or adapted monitoring is indicated.

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