Know Your Risk For Recurrent Bladder Cancer
- Once you’ve completed treatment for bladder cancer, you may think the scary part is over. And you’re right. But just like every other cancer, there’s a risk that your bladder cancer could come back.
- It’s important to continue screenings to catch the cancer in case it does come back because the recurrence rate for bladder cancer is very high — between 30% and 60%.
- Whether you have low-grade or high-grade bladder cancer, it’s important to know how at-risk you are for developing recurrent bladder cancer, as your maintenance screening plan will depend on your risk level.
“How do I make sure it doesn’t come back?” This is the question that probably just popped into your head. Well, it’s impossible to know for sure whether any cancer will come back, including bladder cancer.Read More
Know Your Risk
“I tell a patient who has a low-stage, low-grade tumor that (they) still have a risk of somewhere around 30 percent for this cancer to come back sometime in the next five years,” Dr. Jay Shah, staff surgeon and associate professor of urology at Stanford University, tells SurvivorNet.
But for patients who have high-grade bladder cancer that isn’t invading into the muscle wall of the bladder, Dr. Shah explains, “we know that those patients have a high risk of recurrence, and a fairly high risk of progressing to invasive bladder cancer.”
But for patients who have invasive bladder cancer, Dr. Shah says, “we worry that this is a cancer that’s figured out how to creep into the wall, and given enough time, it will continue to grow and creep, and creep out of the bladder. And that’s when bladder cancer becomes truly deadly — when it spreads to other parts of the bladder.”
Whether you have low-grade or high-grade bladder cancer, it’s important to know how at-risk you are for developing recurrent bladder cancer, as your maintenance screening plan will depend on your risk level, SurvivorNet experts say.
If You’re at Low Risk For Recurrent Bladder Cancer
For patients with low-grade bladder cancer, in order to screen for possible recurrence, your doctor will have to look inside your bladder at regular intervals.
“Someone who’s never had a diagnosis of bladder cancer before (and) is found to have one small, low-grade, low-stage tumor, we’ll plan to look back in with another cystoscopy (a procedure to look inside the bladder using a thin camera) in three months,” Dr. Shah says.
If that shows no signs of cancer growing again within the bladder, then your doctor will start looking every year. But, Dr. Shah explains, if the cancer is growing back, “then we’ll keep looking every three months, and keep scraping, scraping the tumors out as we have to.”
Dr. Shah further explains that doctors know that “if we put a particular medicine into the bladder one time right after we scrape out the tumor, the chance of that tumor coming back goes down by about 30 percent.” If you have a low-stage, low-grade tumor in your bladder, this is something you may see your surgeon talk to you about.
However, if you have low-grade bladder cancer and it comes back, usually when it comes back, it’s still also low grade and low stage, and not deadly. “But we don’t want to miss it, because a small percentage of them can turn into the bad kind,” Dr. Shah says.
If You’re at High Risk For Recurrent Bladder Cancer
The way doctors monitor patients who are at high risk for recurrent bladder cancer is through scans, Dr. Arjun Balar, medical oncologist and assistant professor of medicine at the Perlmutter Cancer Center at NYU Langone Health, tells SurvivorNet. “These include CAT scans and MRIs, and we have to actually look at the whole body — from neck to pelvis,” he says.
“We do chest, abdomen and pelvis imaging for patients who are at higher risk for recurrence,” Dr. Balar says. “I might do them every three months for the first 18 months. (For) other patients who are at lower risk, I might do every four months for the first 18 months.”
“Then after that, the scans are less frequent,” he adds. “The reason we do that is because we know that over time, the risk of recurrence diminishes. In fact, for patients to develop a recurrence of their bladder cancer after three years is actually quite uncommon. Therefore, we tailor our imaging approach, in terms of surveillance, to that risk.”
So, as Dr. Balar explains, for the first 18 months, imaging is more frequent. And after 18 months, the imaging transitions to every six months; after that — by the time a patient has hit the three-year mark — your doctor will transition to yearly imaging.