Treatment Options for Bladder Cancer

Bladder Cancer Recurrence following Cystectomy

Because of the risk of recurrence of bladder cancer after cystectomy, patients require careful follow-up and evaluation after surgery has been completed. Your doctor will establish a specific follow-up schedule for your particular situation and strict compliance with follow-up visits is mandatory to ensure that if the cancer recurs after surgery, it is detected and treated as early as possible. In general, patients treated for superficial disease are followed every 3 to 6 months by cystoscopic evaluation (examination of the urinary tract with a cystoscope to detect cancer or other problems) and urine cytology (examination of urine under a microscope to detect cancer cells). An intravenous pyelogram (a special X-ray of the urinary tract with use of contrast media) is also usually performed annually to look for cancer in other parts of the urinary tract.

Bladder cancer recurrence following radical cystectomy can either be local or distant. Local recurrence refers to the recurrence of a tumor at the site of the surgery or in the nearby (regional) lymph nodes. In general, early stage bladder cancer that is confined to the bladder is associated with a low risk of local recurrence (3% to 6%). In contrast, higher stage tumors that invade the deeper layers of the bladder wall, regional lymph nodes, or nearby organs carry a much higher risk for local tumor recurrence.

Distant recurrence of bladder cancer refers to the recurrence of the cancer in distant sites from the bladder. It has been reported that up to 50% of patients undergoing cystectomy for muscle-invasive bladder cancer eventually develop distant recurrence of the disease (usually within 3 years after cystectomy). Most commonly, distant recurrence involves spread of the cancer to bone, lung, or liver. Patients who develop distant recurrence are treated with combination systemic chemotherapy, with either M-VAC or GC as the standard regimen.