Can Bladder Cancer Come Back

How Can I Prevent Bladder Cancer

You may not be able to prevent bladder cancer, but it may be helpful to know the risk factors that may increase the chance youll develop bladder cancer. Bladder cancer risk factors may include:

• Smoking cigarettes: Cigarette smoking more than doubles the risk of developing bladder cancer. Smoking pipes and cigars or being exposed to second-hand smoke also increases that risk.
• Cancer treatments: Radiation therapy is the second-most common risk factor. People who have certain chemotherapy drugs may also develop an increased risk of bladder cancer.
• Exposure to certain chemicals: People who work with chemicals, such as aromatic amines , are at an increased risk. Extensive exposure to rubber, leather, some textiles, paint and hairdressing supplies, typically related to occupational exposure, also appears to increase the risk.
• Infections: People who have frequent bladder infections, bladder stones or other urinary tract diseases may have an increased risk of developing bladder cancer.
• Past bladder cancer: People with a previous bladder cancer are at increased risk to form new or recurrent bladder tumors.

Systemic Therapy Prior To Cystectomy

Following a radical cystectomy, local recurrence of cancer is uncommon because the cancer and bladder are removed. Some patients however will still develop distant recurrences because undetected cancer cells called micrometastases spread to other locations in the body before the bladder was removed. Treatment with a systemic therapy such as chemotherapy or immunotherapy may reduce or eliminate these micrometastases reducing the risk of cancer recurrence and avoid cystectomy.

Neoadjuvant therapy refers to systemic therapy that is given before surgery. The rationale behind neoadjuvant therapy for bladder cancer is twofold. First, pre-operative treatment can shrink some bladder cancers and therefore, may allow more complete surgical removal of the cancer. Second, because systemic therapy kills undetectable cancer cells in the body, it may help prevent the spread of cancer when used initially rather than waiting for patient recovery following the surgical procedure.

A study published in the New England Journal of Medicine reported that patients with muscle-invasive bladder cancer who received chemotherapy prior to cystectomy had better survival than patients treated with cystectomy alone.1

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How Is Bladder Cancer Staged

Cancer staging describes how much the cancer has grown and invaded the area, explaining the extent of the disease. Bladder cancer is often found at an early stage, as hematuria starts early in the course of the disease. Sometimes bladder cancer can advance to invasive disease before causing symptoms. To best understand staging, you need to know how cancer spreads and advances in stage.

Cancers can spread and disrupt how normal organs work. Bladder cancers often begin very superficially, involving only the lining of the bladder. Bladder cancers can invade the bladder wall, involving the muscular layers of the wall. As bladder cancer grows it can invade the entire way through the wall and into the fat surrounding the bladder or even into other organs . This local extension is the most common way bladder cancer spreads.

When cancer spreads to another area in the body, that area is called metastasis. Cancer can also spread through the lymph system and the bloodstream. Bladder cancer often spreads locally or to lymph nodes before spreading distantly, though this is not always the case. The lungs and bones are the most common areas for metastases to develop. When bladder cancer spreads to another area, it is still bladder cancer. For instance, if it spreads to the lung, it is not called lung cancer, but bladder cancer that has metastasized to the lung. If we look at the affected lung tissue under a microscope, it will look like bladder cancer cells.

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Treatments For Recurrent Bladder Cancer

means that the cancer has come back after it has been treated. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

How recurrent bladder cancer is treated depends on many factors, including:

• where the cancer comes back
• the treatments youve already had
• when it comes back after initial treatment
• if the treatments didnt work and the cancer continues to grow

The following are treatment options for recurrent bladder cancer.

How Do I Take Care Of Myself

About half of all people with bladder cancer have early-stage cancer thats relatively easy to treat. But bladder cancer often comes back . People whove had bladder cancer will need regular checkups after treatment. Being vigilant about follow-up care is one thing you can do to take care of yourself. Here are some other suggestions from the Bladder Cancer Advocacy Network include:

• Follow a heart-healthy diet: Plan menus that include skinless poultry and fish, low-fat dairy products, nuts and legumes, and a variety of fruits and vegetables.
• Focus on high-fiber foods: Bladder cancer treatment may cause digestive issues and a fiber-rich diet may help.
• Get some exercise: Gentle exercise may help manage stress.
• Connect with others: Bladder cancer often comes back. Its not easy to have a rare disease thats likely to return. Connecting with people who understand what youre going through may help.

Urinary diversion

Some people with bladder cancer need surgery that removes their bladder and their bodies natural reservoir for pee. There are three types of urinary diversion surgeries. All three types involve surgically converting part of your intestine to become a passage tube for pee or a reservoir for storing pee.

Urinary diversion may be a challenging lifestyle change. If youll need urinary diversion surgery, ask your healthcare provider to explain each surgery types advantages and disadvantages. That way, youll know what to expect and how to take care of yourself.

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Olivia Newton John Says She Uses Cannabis To Help Treat Her Cancer

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Cancer Research UK says that bladder cancer is the 11th most common cancer in the UK, and the eighth most common cancer in men. The bladder is part of the urinary system, which filters waste products out of your blood and makes urine. If bladder cancer spreads to other parts of the body, such as other organs, its known as metastatic bladder cancer. Many of the signs of bladder cancer can show in your urine, but there are also a number of other signs which some people may experience.

Selecting And Testing Gemcitabine

When Dr. Messing began research on gemcitabine as a possible way to reduce recurrences more than a decade ago, the drug was not widely used for bladder cancer. “We tried to pick an agent that we thought would be safe and effective,” he said.

The researchers decided to compare gemcitabine against placebo rather than mitomycin C, based on studies showing how infrequently patients received some form of chemotherapy following surgery despite guidelines recommending this approach.

“If the new procedure were adopted widely, we could spare patients a lot of suffering from repeated surgeries and save health care costs associated with those surgeries,” Dr. Messing said.

“Now that we have the results of the trial,” he went on, “we hope that patients and physicians will embrace this approach to treatment.”

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Can I Lower My Risk Of Cancer Returning

Unfortunately, researchers do not yet understand exactly what causes bladder cancer to recur in some people, but not in others.2 There are studies being carried out to try and find out if there are any vitamins, minerals, supplements, or medicines that might help to reduce the risk of recurrence. But as of now, there is no proof that any of these things have an effect on the chance that bladder cancer will recur.

Maintaining a healthy body and lifestyle is good for your overall health, however. Following a healthy diet, staying active, and avoiding unhealthy behaviors, such as smoking, is a good idea for everyone. If you find yourself worrying about bladder cancer recurrence, stress-relieving activities such as exercise or meditation might help to reduce your anxiety.

Comparison Of Recurrence Risk Among Patients With Different Eortc

During the five-year follow-up period, 33 of 94 patients experienced intravesical recurrence, including 3 cases in the low-risk group, 7 cases in the intermediate-risk group, and 23 cases in the high-risk group. In addition, the KaplanMeier analysis demonstrated that the EORTC-GUCG risk scoring system had a significant correlation with RFS, and the high-risk group patients had shorter RFS than the other two groups .

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What Are The Treatment Options For Bladder Cancer

There are four types of treatment for patients with bladder cancer. These include:

Sometimes, combinations of these treatments will be used.

Surgical options

Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.

• Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
• Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
• Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .

Chemotherapy

Radiation therapy

Radiotherapy With A Radiosensitiser

Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.

A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:

• difficulty passing urine

Most of these side effects should pass a few weeks after your treatment finishes, although theres a small chance theyll be permanent.

Having radiotherapy directed at your pelvis usually means youll be infertile .

After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.

You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.

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To Confirm The Diagnosis

Urine microscopyA sample of urine can be sent to the laboratory to look for cancerous cells under the microscope. This test may detect cancer cells. However, if no cancer cells are seen it does not rule out bladder cancer. Further tests are done to confirm or rule out the diagnosis if symptoms suggest bladder cancer.

CystoscopyCystoscopy is commonly done to confirm a bladder tumour. Having a cystoscopy entails a doctor or nurse looking into your bladder with a special thin telescope called a cystoscope. The cystoscope is passed into your bladder via your water pipe . A cystoscopy which is done just to look into your bladder is normally carried out under local anaesthetic. If a procedure is done, such as removing a tumour via a cystoscope, a general anaesthetic is usually used.

During cystoscopy a doctor or nurse can:

• See any areas on the lining of your bladder which look abnormal.
• Take small samples of suspicious areas. A small sample of tissue is removed from a part of the body and then examined under the microscope to look for abnormal cells.
• Remove a superficial tumour with instruments which can be passed down a side channel of the cystoscope.

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Bladder Cancer: The Symptoms You Shouldnt Ignore

One patient shares his experience being diagnosed with a disease he knew nothing about.

A recent survey showed that almost two-thirds of adults are unaware of the signs of bladder cancer, with 10% having never even heard of the disease.1 Yet bladder cancer is one of the top 10 most common cancers in the world.2

One of the groups of people most at risk of bladder cancer are older men5 and this proved true for Dave from Torquay, UK.

Dave was diagnosed with bladder cancer in 2008 when he was aged 61. At the time of diagnosis, he knew nothing about the disease or its signs and symptoms. Based on his experiences he is keen to raise awareness about bladder cancer, by sharing his story.

It was Christmas Eve and we had finished dinner, explains Dave. After dinner, I went to the toilet and I noticed my urine was blood red. It was a real shock. Immediately, I told my wife as soon as I discovered blood in my urine we both didnt know what to do. Although Dave didnt know it at the time, this was a symptom of bladder cancer. In fact, the most common.3,5 Other symptoms include abdominal pain, lower back pain and bladder irritation. 3,5

Dave was quick to act once he spotted the change in his urine. He explains, As soon as my doctors surgery opened after Christmas, I booked an appointment and was referred straight away. Within a couple of days I went to see a urologist.

Visit the campaign website: www.wecarecampaign.org

References

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Determining The Stage And Extent Of Your Cancer

Once your physician confirms you have cancer of the bladder, they might recommend additional testing to determine if the cancer has spread to other areas of your body, like your lymph nodes.

Testing might include:

The doctor will use the information from this testing to determine the stage of your cancer. The bladder cancer stages are indicated by a 0 to IV range of Roman numerals. The lowest cancer stages indicate itâs confined to your bladderâs inner layers and hasnât begun affecting your muscular bladder wall. Stage IV, the highest stage, indicates the cancer has begun spreading to distant organs and lymph nodes of your body.

The cancer stages system is continually evolving and becoming more complex with the improvement of cancer diagnosis and treatment. The stage of cancer you have will also determine which treatment will serve you best.

For more information on bladder cancer stages, please refer to the American Cancer Society website.

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Tests That May Be Done

Physical exam: The doctor will check you for signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, a pelvic exam might also be done. During these exams, the doctor can sometimes feel a bladder tumor.

Urine tests: For these tests, you’ll be asked to pee in a cup. Your urine is then tested for cancer cells, blood, or certain proteins .

Cystoscopy: For this exam, a doctor called a urologist looks at the inside of your bladder using a tool called a cystoscope. This is a thin tube with a tiny light and camera on its end. It’s put through the opening of your urethra and moved up into your bladder.

Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and then glow when the doctor shines a blue light through the scope. This can help the doctor see cancer cells that might have been missed with the normal light.

Bladder biopsy: This is needed to know for sure if you have bladder cancer. For this test, a cystoscope is used it to take a tiny piece of the bladder . More than one sample may be taken because sometimes cancer starts in more than one part of the bladder. Salt water washings of the inside of your bladder may also be collected to look for cancer cells. Any samples are sent to a lab and tested to see if there are cancer cells in them.

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Fatigue And Weakness Is Not Normal

Do you feel tired and weak with little to no interest in your normal activities? If you are sleeping more than your usual amount, and are still constantly tired, this may be a symptom of bladder cancer. Although fatigue and weakness are not common symptoms, they can happen to those in the advanced stage of the disease.

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Relapse Of Pt0 Bladder Cancer Possible After Radical Cystectomy

Despite the favorable prognosis associated with pathologic T0 bladder cancer, relapse can occur, especially among patients with positive lymph nodes, investigators reported at the 22nd annual meeting of the Society of Urologic Oncology.

Using the International Robotic Cystectomy Consortium database, Ahmed Aly Hussein, MD, MS, and colleagues from Roswell Park Comprehensive Cancer Center in New York, New York, identified 471 patients with pT0 bladder cancer or absence of residual tumor at the time of robot-assisted radical cystectomy . Of the cohort, 37% had received neoadjuvant chemotherapy. Positive lymph nodes were found in 5%.

Bladder cancer relapsed in 7% of patients, including 3% with local and 5% with distal recurrence, Dr Husseins team reported. The most common sites of both local and distant recurrences were the pelvis and lungs . No patient had peritoneal recurrence.

At 5 years, recurrence-free, disease-free, and overall survival rates were 88%, 93% and 79%, respectively.

According to a multivariate model, positive lymph node status and reoperation within 30 days significantly increased the risk for recurrence by 10.2- and 7.1-fold, respectively, and all-cause mortality by 4.9- and 3.5-fold, respectively, Dr Husseins team reported. Chronic kidney disease was another risk factor for worse overall survival, and older age was another risk factor for recurrence. Predictors for disease-free survival could not be calculated due to the small number of patients.

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