Patients with recurrent bladder cancer have cancer that has returned following initial treatment with surgery, radiation, chemotherapy or immunotherapy.

A variety of factors ultimately influence a patient's decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient's chance of cure, or prolong a patient's survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of recurrent bladder cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Recurrent Superficial Bladder Cancer

Patients with a diagnosis of superficial bladder cancer have frequent recurrences of cancer throughout their lives. Most of the time, these recurrences are non-invasive and not life threatening. Treatment of recurrent superficial bladder cancer essentially uses the same treatment approaches as were initially offered. Go to stage I to learn about treatment options. In some instances, partial or total bladder resection may be utilized to control recurrent superficial bladder cancers.

Treatment of Patients with Superficial Bladder Cancer That Progress to Stage II-IV Bladder Cancer

Approximately 20-40% of all patients with superficial bladder cancer will ultimately progress to more advanced stages or muscle invasive bladder cancer. When this occurs, patients are treated based on new staging of the current more invasive bladder cancer. For treatment of patients with superficial bladder cancer who have progressed, select one of the following:

Stage II

Stage III

Stage IV

Patients that were initially treated for stage II-IV bladder cancer and experience a recurrence have fewer treatment options. If patients have received prior chemotherapy treatment, the main treatment options are to receive additional chemotherapy treatment with drugs to which they have not been previously exposed or to participate in a clinical trial evaluating new treatments.

Chemotherapy Treatment of Recurrent Bladder Cancer

Selection of a chemotherapy regimen for recurrent bladder cancer depends primarily on previous treatment. Patients are usually treated with drugs that they have not previously received.

Before the development of effective chemotherapy, the average survival of patients with recurrent bladder cancer was only 3-6 months from diagnosis. Bladder cancer, however, is sensitive to chemotherapy and may respond to treatment frequently and rapidly. Although long-term survival has been reported in some patients, chemotherapy is administered primarily to improve the symptoms of bladder cancer. Patients in good clinical condition should enter treatment with curative intent because some patients have prolonged remissions without cancer recurrences.

Combinations of chemotherapy agents are usually used for treatment of bladder cancer, as no single chemotherapy agent will produce a complete response in more than an occasional patient. Platinol® chemotherapy has been considered to be the most active agent, followed by methotrexate, Velban®, doxorubicin or cyclophosphamide. More recent clinical studies suggest that some newer chemotherapy agents including paclitaxel and Gemzar® may be as effective as methotrexate, Velban®, doxorubicin or cyclophosphamide with fewer side effects. For example, the complete response rate to single agent paclitaxel administered with Neupogen to hasten blood cell recovery has been reported to be 27%, which is similar to treatment with combination chemotherapy. The complete response rate to single agent Gemzar® is approximately 10%. However, no direct comparisons have been made between these two new agents and the more commonly used drugs.

Various combinations and schedules of Platinol®, methotrexate, Velban®, doxorubicin and/or cyclophosphamide have been evaluated over the past 10-15 years. Complete response rates range from 14% to 20% and partial responses range from 46-57%. The most commonly used treatment regimen combines methotrexate, Velban®, doxorubicin and Platinol® (MVAC). This regimen produces complete responses in approximately 20% of patients and the responses last an average of 38 months.

A recent clinical trial suggests the combination of Gemzar®/Platinol® is as effective against transitional cell carcinoma of the urothelium as MVAC, but with fewer side effects. Researchers from 19 countries treated 396 patients who had metastatic bladder cancer with either MVAC or Gemzar®/Platinol® chemotherapy. The researchers then directly compared overall survival, response rates to treatment, the time it took for the disease to progress, side effects and quality of life among the two treatment groups. The results indicated that overall survival between patients receiving MVAC and those receiving Gemzar®/ Platinol® was similar; however, the Gemzar®/ Platinol® therapy was better tolerated and resulted in fewer side effects. These findings suggest that the Gemzar®/ Platinol® combination is an effective treatment option for metastatic stage IV bladder cancer because it appears to produce fewer side effects than the more commonly used MVAC regimen. The researchers concluded that Gemzar®/ Platinol® should be considered a new standard treatment.

In other diseases, another chemotherapy agent, Paraplatin®, has been compared to Platinol® and found to have fewer side effects and similar anti-cancer activity. Because of the reduced side effects, more recent studies have supported the use of Paraplatin® combined with newer drugs such as paclitaxel and Gemzar®. The combination of Paraplatin® and paclitaxel has been evaluated in newly diagnosed patients with metastatic bladder cancer. The complete response rate was reported to be 40%, while the partial response rate was 25% and 15% of patients had stable disease.

Surgery for Recurrent Bladder Cancer

Radical cystectomy (removal of the bladder, tissue around the bladder, the prostate and seminal vesicles in men and the uterus, fallopian tubes, ovaries, anterior vaginal wall and urethra in women, with or without pelvic lymph node dissection) is sometimes recommended for treatment of patients with recurrent bladder cancer to control local spread and the complications this creates. Surgery is also utilized after an incomplete response of the cancer to radiation therapy and/or chemotherapy.

Strategies to Improve Treatment

The progress that has been made in the treatment of bladder cancer has resulted from improved treatments evaluated in clinical trials. Future progress in the treatment of bladder cancer will result from continued participation in appropriate studies. Currently, there are several areas of active exploration aimed at improving the treatment of bladder cancer.