Bladder Cancer Recurrence: The Importance of Surveillance

Bladder cancer is usually treatable - especially when caught early. Unfortunately the disease also has one of the highest rates of recurrence, and it’s relatively common for people who are diagnosed with bladder cancer to experience a return of their cancer at least once following initial treatment. For some types of bladder cancer, the risk of recurrence is very high.

There are a number of different reasons why bladder cancer can recur and it is not always easy to predict who is at risk. As a result, regular monitoring and surveillance following treatment is important for helping to detect bladder cancer recurrence early, and ensuring the best chance of a good outcome for patients.

Why Can Bladder Cancer Recur?

Bladder cancer develops when cells in the bladder begin to grow, divide, and spread in an uncontrolled way, leading to the formation of a malignant tumor. Although treatments can be very effective at removing tumors, a small number of cancerous cells can sometimes remain. Bladder cancer can recur when cancer cells left behind begin to grow again, after treatment has finished.

Sometimes patients who have been previously treated for bladder cancer can go on to develop a different type of cancer in the bladder, or elsewhere in the body- this is known as a secondary cancer.

Who Is Most at Risk of Bladder Cancer Recurrence?

A person’s individual risk for bladder cancer recurrence can depend on a number of different factors, including the type and stage of cancer, success of initial treatment, and demographic and lifestyle factors such as age and smoking history.¹

Researchers don’t yet understand all of the reasons why bladder cancer can recur, or who will definitely experience recurrence of their cancer.

This is one of the reasons why physicians strongly recommend that people who have previously been diagnosed with bladder cancer have regular ongoing check-ups following treatment. This is sometimes called ‘active surveillance’.

How Often Does Bladder Cancer Recur?

Recurrence rates for bladder cancer can be quite high compared to other types of cancer. Generally, over half of all people who develop bladder cancer may experience recurrence of their cancer following treatment.

Non-muscle invasive bladder cancer recurrence

‘Non-muscle invasive’ bladder cancer is the most common bladder cancer diagnosed. It is considered to be early-stage, as the cancer cells are present only in the inner lining of the bladder.

Chances of recurrence can be very high for non-muscle invasive bladder cancer. Around 31% to 78% of people with this cancer will develop recurrence or a secondary bladder cancer within 5 years following treatment, depending on risk-factors.²

Muscle-invasive bladder cancer recurrence

‘Muscle invasive’ bladder cancer means the cancer has grown into the muscle layer of the bladder. This cancer is less commonly diagnosed, but can be more aggressive and have a high rate of recurrence and progression. Patients with muscle-invasive bladder cancer often need a more aggressive treatment regime, and chances of recurrence following treatment can still be around 30% to 54%.³

It can also be very difficult to predict when bladder cancer may recur. Bladder cancer can sometimes come back up to 5, 10, or even 15 years after treatment.^4,5

This means that if you have been previously diagnosed with bladder cancer, you may be asked to undergo extra surveillance check-ups and monitoring for any recurrence for many years after initial treatment.

Why Is Early Detection of Bladder Cancer Recurrence Important?

Early detection can help to ensure any recurrence is treated promptly. The sooner new cancer growth is detected, the more time and options are available for managing the condition appropriately.

Many bladder cancers that recur remain treatable and do not spread or progress. But there is always the chance that as the cancer comes back, it will progress to a more dangerous form. For example, for patients with non-muscle invasive bladder cancer, 10% to 30% may eventually experience disease progression to life-threatening muscle-invasive bladder cancer, though this figure is much smaller for low-risk tumors.⁶

Research suggests that early bladder cancer detection through routine clinical check-ups and using diagnostic tests for those with symptoms or at risk could be an effective way to help improve patient survival.⁷

As well as helping to detect any potentially problematic changes in good time, some people also find that keeping in regular touch with a healthcare team and following a regular schedule of follow-up health checks can be reassuring, and help to provide a sense of control while adapting to life after cancer.

Recommendations for Bladder Cancer Surveillance and Monitoring

If you’ve been diagnosed with bladder cancer, your healthcare team will often develop a personalized follow-up surveillance plan with you outlining the recommended number and type of check-ups you will need after treatment. This plan is usually tailored based on medical guidelines and reflects the risk of recurrence of bladder cancer.

Guidelines for surveillance of bladder cancer recurrence

The frequency and type of surveillance check-ups recommended for bladder cancer recurrence is often based on the presence or absence of a number of individual risk factors, and whether your cancer is categorized as low-risk, intermediate-risk, or high-risk.

In general terms, American Urological Association guidelines recommend a medical check-up within 3 to 4 months following treatment, then again up to 4 times a year for the first 4 or 5 years, and annually, or at the patient’s and physician’s discretion after that.⁸

If several years of surveillance have gone by and no cancer recurrence is detected, a single check-up once a year may then be enough, depending on various factors.

Patient monitoring for signs and symptoms of bladder cancer

Staying aware for possible signs and symptoms of bladder cancer is also an important way patients can help to detect any early possible signs of bladder cancer recurrence. Appearance of blood in urine can be the most common symptom of a possible cancer recurrence.

Other symptoms such as changes to urination frequency or urgency, and pain during urination can also be important indicators. You should always discuss any new symptoms or worrying changes with a physician.

Procedures Used During Bladder Cancer Monitoring and Surveillance

A patient’s follow-up surveillance plan might contain a number of different medical exams and procedures.

Cystoscopy

Cystoscopy bladder examinations are recommended as an integral part of a patient’s follow-up plan. During cystoscopy, a thin tube called a cystoscope is inserted into the bladder through the urethra. A light and camera are then used to check the lining of the bladder. If any unusual areas are noticed, a small sample of tissue called a ‘biopsy’ can be taken for analysis in a laboratory.

Non-invasive genomic urine tests

In many cases, non-invasive urine-based biomarker tests such as Cxbladder Monitor can also be used as part of a patient’s follow-up surveillance plan to help rule out bladder cancer recurrence. Using Cxbladder Monitor in combination with cystoscopy on an alternating schedule can help to reduce the frequency of cystoscopy required.
Learn more about Cxbladder

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Other procedures and tests used during check-ups

A number of other procedures may also be used alongside cystoscopy and non-invasive urine testing of biomarkers as part of a patient’s follow-up surveillance plan. Depending on patient need, additional procedures can include radiographic imaging to visualize the upper urinary tract, and also urine cytology, which involves microscopic examination of urine for cancer cells.

If you’re a patient monitoring for bladder cancer recurrence, ask your doctor about Cxbladder

Cxbladder is a genomic urine test designed to quickly and accurately rule out bladder cancer. The test analyzes five biomarker genes to help rule out the disease, reducing the need for further invasive procedures.

Cxbladder Monitor is a non-invasive surveillance alternative that can reduce the burden of cystoscopy in those being monitored for recurrent non-muscle invasive bladder cancer. In suitable cases following diagnosis and treatment, Monitor can reduce the frequency of invasive cystoscopy required to enhance comfort. When no recurrence has been detected after several years, Cxbladder Monitor test may provide an alternative to cystoscopy after consulting with your physician.
Learn more about Cxbladder Monitor Contact us for more information

References

Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006 Mar;49(3):466-5; discussion 475-7. doi: 10.1016/j.eururo.2005.12.031. PMID: 16442208.
Flaig TW, Spiess PE, Agarwal N, et al. Bladder Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020 Mar;18(3):329-354. doi: 10.6004/jnccn.2020.0011. PMID: 32135513.
Mari A, Campi R, Tellini R, et al. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol. 2018 Feb;36(2):157-170. doi: 10.1007/s00345-017-2115-4. Epub 2017 Nov 16. PMID: 29147759; PMCID: PMC5799348.
Holmäng S, Ströck V. Should follow-up cystoscopy in bacillus Calmette-Guérin-treated patients continue after five tumour-free years? Eur Urol. 2012 Mar;61(3):503-7. doi: 10.1016/j.eururo.2011.11.011. Epub 2011 Nov 15. PMID: 22119022.
Kobayashi H, Kikuchi E, Mikami S, et al. Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression. BMC Urol. 2014 Jan 8;14:5. doi: 10.1186/1471-2490-14-5. PMID: 24400640; PMCID: PMC3913327.
Miyake M, Fujimoto K, Hirao Y. Active surveillance for nonmuscle invasive bladder cancer. Investig Clin Urol. 2016 Jun;57 Suppl 1(Suppl 1):S4-S13. doi: 10.4111/icu.2016.57.S1.S4. Epub 2016 May 27. PMID: 27326406; PMCID: PMC4910757.
Cumberbatch MGK, Noon AP. Epidemiology, aetiology and screening of bladder cancer. Transl Androl Urol. 2019 Feb;8(1):5-11. doi: 10.21037/tau.2018.09.11. PMID: 30976562; PMCID: PMC6414346.
Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline (2020). https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-muscle-invasive-guideline#x2563