Suspected Bladder Cancer Recurrence
- If you were diagnosed with bladder cancer and successfully treated, you are most likely going through maintenance therapy, or surveillance.
- This is done in order to make sure your cancer doesn't come back, or if it does, catch it early enough to treat it.
- "What happens when a cancer recurs is we generally investigate it a little bit more," Dr. Mark Tyson says. "We take the patient to the operating room, maybe get a CT scan, biopsy the tumor, and understand the natural history of that tumor by studying at stage and grade."
"Surveillance after bladder cancer surgery is extremely important," Dr. Arjun Balar, director of the genitourinary medical oncology program at NYU Langone's Perlmutter Cancer Center, tells SurvivorNet.
Read More"What I tell patients is that we have to monitor you very closely,” Dr. Balar says. “The risk of recurrence, even despite chemotherapy in surgery, is highest within the first two to three years, and especially within the first year."
But, he adds, “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.”
Dr. Dan Theodorescu, director of the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai, adds to Dr. Balar’s point, noting that “there’s a fairly high chance of recurrence overall of bladder cancer, much more so than other cancers.”
Managing Advanced-Stage Bladder Cancer
Dr. Theodorescu says that the first important thing patients must keep in mind when beginning their bladder cancer surveillance is that “it is very important that they have regular follow-up with their urologist and at regular intervals.”
The way in which your bladder cancer is surveyed depends on the stage and type of your cancer, but typically, cystoscopies are done regardless of the stage or type.
Surveillance after radical cystectomy is different than surveillance after transurethral tumor resection. In the post-cystectomy setting, disease monitoring is done primarily through scans such as CT scans. For patients who still have their bladders, surveillance is done primarily through cystoscopy, with periodic imaging in certain cases.
A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope. The camera is attached to a long tube that's inserted into the urethra, then into the bladder. The purpose of this procedure is to see if there are cancerous nodules, Dr. Balar says. Those nodules, if detected during bladder cancer surveillance, could mean a recurrence of the disease.
As Dr. Theodorescu notes, it’s important to have regular follow-ups with your urologist. This is because your urologist is typically the one who carries out a cystoscopy procedure.
Dr. Balar says that CT scans and MRIs are usually involved as well. "We have to actually look at the whole body from neck to pelvis," he says.
"… so a patient who has a history of bladder cancer undergoes periodic surveillance (with a cystoscopy)," Dr. Mark Tyson, a urologic oncologist with a subspecialty interest in bladder cancer at the Mayo Clinic Arizona in Phoenix, tells SurvivorNet. (Dr. Tyson equates the cystoscopy to a colonoscopy, only in the bladder.) "It is intended to detect these cancer recurrences early."
"What happens when a cancer recurs is we (the patient's doctors) generally investigate it a little bit more," he says. "We take the patient to the operating room, maybe get a CT scan, biopsy the tumor, and understand the natural history of that tumor by studying at stage and grade."
Once doctors have the stage and grade of the cancer, Dr. Tyson says, "then we are able to formulate a plan based upon the patient's history and previous response to therapy."
“(Cancer surveillance) is risk adapted,” Dr. Tyson says, “and it’s different for each patient, but generally speaking, the surveillance is lifelong.”
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