Can Bladder Cancer Return After Bladder Removal?
While there are several different treatments for bladder cancer available, many patients with high-risk or muscle-invasive cancer will undergo a procedure known as a radical cystectomy, or total removal of the bladder. A radical cystectomy (often with the removal of some of the surrounding pelvic lymph nodes and other organs) is considered standard treatment for many high-risk bladder cancers. Patients who undergo a radical cystectomy may wonder if their cancer can return if they no longer have a bladder. This article will look at the possibilities of recurrence, and some of the risk factors for recurrence in bladder cancer patients who have undergone a radical cystectomy.
Study of people who underwent a radical cystectomy
In 2017, a group of researchers looked at the long-term outcomes of 1652 patients who underwent a radical cystectomy and removal of lymph nodes to treat their bladder cancer. These patients were treated at 3 different centers and had their surgeries between 1988 and 2012. None of these patients had post-surgery chemotherapy or biologic agents, also known as “neoadjuvant therapy”, which could change the results of the data.
About one third had cancer recurrence
Of these patients, 548 had bladder cancer recurrence, most of whom experienced recurrence in the first 5 years after their radical cystectomy (88% or 481 patients). Late recurrence (classified as happening more than 5 years after treatment) occurred in 67 (or 12%) of study patients. The average amount of time to bladder cancer recurrence was 12 months, with 80% of recurrences happening in the first three years. These 548 recurring bladder cancer patients account for about 33% (or a third) of the study patients who were treated, which is less than the national average of 50% of patients having bladder recurrence.
Most common sites
The most common site of recurrence of bladder cancer after a radical cystectomy, both in early and late recurrence, was in the abdomen or pelvic region, in about 60-70% of patients. The next most common sites of recurrence were the chest and the bones, with the chest more common in early recurrence, and the bones in late recurrence. Other sites included the brain and the urothelial regions (that is the urethra, ureters, and kidney area); these areas tend to be the least common areas of bladder cancer recurrence. Just under 40% of patients (both early and late recurrence bladder cancer) had a recurrence in multiple regions.
Risk factors for late recurrence
While there don’t seem to be many risk factors for early bladder cancer recurrence, there are a few risk factors for late recurrence of bladder cancer that have been noted in multiple studies. Multiple studies have shown that having a radical cystectomy at a younger age can be a risk factor for recurrence. Patients who have bladder cancer that is not confined to the bladder, or that has involvement in the surrounding muscle tissue may also be at risk for late recurrence, but there is a need for more studies to show a better correlation. Finally, bladder cancer that involves the prostate may also be at risk for a late recurrence.
Patients who have a late recurrence of bladder cancer after a radical cystectomy have better outcomes than patients who have an early recurrence. This may be due, in part, to the location of the recurrence of bladder cancer and the types of bladder cancer that occur at a later stage; but again, there is a need for further study to show a stronger correlation between these factors.
Importance of annual check-ups
While this study, and others like it, have some limitations, (since the information is retroactive, it is not standardized, and there may be some variations that can’t be accounted for in statistical analysis) it makes the very important point that patients who have had a radical cystectomy to treat bladder cancer need to continue to have check-ups, even 5-10 or more years after their surgery. It is important to talk to your care team about the best follow-up schedule to fit your needs and risk factors, and to not ignore these appointments when the time comes. They are still important factors in your bladder cancer care.
Did you know that May is Bladder Cancer Awareness Month?