Treatments for recurrent bladder cancer

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 you’ve already had
• when it comes back after initial treatment
• if the treatments didn’t work and the cancer continues to grow (called treatment failure)
• the grade

The following are treatment options for recurrent bladder cancer.

A non-invasive recurrence is only in the inner lining of the bladder. A non-muscle-invasive recurrence is in the connective tissue layer of the bladder. These types of recurrence may also be called a local recurrence.

Treatments often depend on if the recurrence happens soon after treatment or later. If the cancer comes back 6 to 12 months after treatment, it is called an early recurrence. If the cancer comes back 12 months or more after treatment, it is called a late recurrence.

Non-invasive and non-muscle-invasive recurrences are treated the same as early stage bladder cancer.

Find out more about treatments for early stage bladder cancer.

A muscle-invasive recurrence is when the cancer has grown into the muscle layer of the bladder. A locally advanced recurrence is in the tissue or organs just outside the bladder or in nearby lymph nodes.

Surgery may be used to treat muscle-invasive and locally advanced recurrences. It is usually done if you were treated with a bladder-preserving approach and the bladder wasn’t removed.

A radical cystectomy removes the whole bladder and sometimes tissue and organs surrounding the bladder. Urinary diversion surgery is needed once the bladder is removed.

A urinary diversion makes a new way to hold urine (pee) and pass it out of the body. It is done after a radical cystectomy. A urinary diversion may also be done if there is a blockage and urine can’t leave the body.

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It is done following a radical cystectomy, usually during the same surgery.

A transurethral resection of bladder tumour (TURBT) removes tumours from the bladder through the urethra. It may be done to control symptoms when a cystectomy can’t be done.

Chemotherapy is usually offered for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation if radiation therapy wasn’t already used.

Chemotherapy is usually given as a systemic therapy. If the cancer comes back more than 12 months after treatment, a combination of chemotherapy drugs that includes cisplatin is commonly used. If the cancer comes back within 12 months of treatment, immunotherapy is used instead.

You may be offered external radiation therapy for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation. External radiation therapy may also be used alone if surgery can’t be done.

You may be offered immunotherapy for a locally advanced recurrence. An immune checkpoint inhibitor is an immunotherapy drug that may be used if the cancer comes back within 12 months of finishing chemotherapy that includes cisplatin.

The immune checkpoint inhibitors that may be used are:

• pembrolizumab (Keytruda)
• durvalumab (Imfinzi)
• avelumab (Bavencio)

Enfortumab vedotin (Padcev) is a type of monoclonal antibody. You may be offered enfortumab vedotin if you have recurrent bladder cancer that has already been treated with cisplatin or carboplatin and a PD-1 or PD-L1 immune checkpoint inhibitor. It may also be a treatment option if you can't be treated with cisplatin or carboplatin.

A distant recurrence means the cancer comes back in another part of the body. It is also called metastatic bladder cancer.

Find out more about treatments for metastatic bladder cancer.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with bladder cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.