Treatments for recurrent bladder cancer
Recurrent bladder cancer means that the cancer has come back after it has been treated. The following are 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.
The treatments offered for recurrent bladder cancer depend on:
- the stage
- previous treatments
- your personal needs, including whether or not you can have or want further treatment
Recurrent bladder cancer that is only in the lining of the bladder and hasn’t grown into the bladder wall (called non-invasive bladder cancer) may be treated with bladder-preserving surgery. This type of surgery does not remove all or most of the bladder, which helps to keep the bladder function as normal as possible.
Recurrent bladder cancer that has grown into the deeper layers of the bladder wall, such as the connective tissue and the muscle layer (called invasive bladder cancer) may need more aggressive treatment, such as a cystectomy.
Bladder cancer that recurs in distant organs may be treated with chemotherapy or radiation therapy.
You may be offered surgery for recurrent bladder cancer. The following types of surgery may be done:
Transurethral resection (TUR)
A transurethral resection (TUR) uses a special instrument passed through a cystoscope to remove the tumour and a margin of healthy tissue around it. The surgeon then burns the area from where the tumour was removed with a high-energy electric current (called fulguration) or a laser. This procedure seals off blood vessels and destroys any remaining cancer.
A partial, or segmental, cystectomy removes the tumour and part of the bladder. It may be a treatment option for recurrent bladder cancer that is only in one area of the bladder (called localized cancer) and hasn’t spread to other parts of the body.
A radical cystectomy removes all of the bladder, surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed. In men, the prostate may be removed. In women, the ovaries, the uterus or part of the vagina may be removed. After removing the bladder, the surgeon creates a new passage for the urine (called a urinary diversion).
A radical cystectomy may be an option for tumours in the lining of the bladder that keep coming back after treatment with a TUR, intravesical immunotherapy or intravesical chemotherapy. (Intravesical means that the drug is given directly into the bladder). It may also be used to treat cancer that has spread only to organs in the pelvis and lymph nodes near the bladder (called regional lymph nodes). In this case, a radical cystectomy is usually done after you receive chemotherapy. A radical cystectomy may also be used to relieve symptoms and improve quality of life (called palliative surgery).
You may be offered chemotherapy for recurrent bladder cancer. The drugs may be given directly into the bladder (intravesical chemotherapy) or may circulate throughout the body (systemic chemotherapy).
The following drugs are used in intravesical chemotherapy to treat recurrent cancer that is only in the lining of the bladder:
- mitomycin (Mutamycin)
- doxorubicin (Adriamycin)
- epirubicin (Pharmorubicin)
Systemic chemotherapy can be used to treat different stages of bladder cancer that recur. The following combinations of chemotherapy drugs are used in systemic chemotherapy:
- GemCIS, or GC – gemcitabine (Gemzar) and cisplatin (Platinol AQ)
- MVAC – methotrexate, vinblastine (Velbe), doxorubicin and cisplatin
- CMV – cisplatin, methotrexate and vinblastine
Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behaviour of cancer cells.
Intravesical immunotherapy may be offered for recurrent bladder cancer in the lining of the bladder. A catheter, or tube, is passed through the urethra and into the bladder so that the drug is given directly into the bladder. The most common intravesical immunotherapy drug used is bacillus Calmette-Guérin (BCG).
Immunotherapy may be offered for recurrent bladder cancer as a second-line therapy if the cancer has recurred within 12 months after finishing chemotherapy with cisplatin. The immunotherapy drugs that may be used are:
- pembrolizumab (Keytruda)
- durvalumab (Imfinzi)
- avelumab (Bavencio)
External beam radiation therapy may be given as an alternative to surgery for recurrent cancer that is stage 2 or stage 3. It is usually given as well as chemotherapy. Radiation can also be used as palliative treatment to relieve symptoms if the recurrence is found at an advanced stage.
You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.
Treatment given for a condition or disease (such as cancer) when the first-line therapy (the first or standard treatment) does not work or stops working.
Also called secondary therapy or secondary treatment.
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