Management of recurrent or persistent non-muscle invasive bladder cancer
- Peter Black, MD, FACS, FRCSC
Peter Black, MD, FACS, FRCSC
- Khosrowshahi Chair in Bladder Cancer Research
- Associate Professor
- Department of Urologic Sciences
- University of British Columbia
- Vancouver Prostate Centre
- Wassim Kassouf, MD, CM, FRCS
Wassim Kassouf, MD, CM, FRCS
- Associate Professor and Program Director
- McGill University Health Center
Approximately 70 percent of new urothelial (formerly called transitional cell) bladder cancer cases are classified as non-muscle invasive . Non-muscle invasive bladder cancer includes Ta, T1 (submucosal invasive) tumors, and Tis (carcinoma in situ [CIS]), which account for approximately 70, 20, and 10 percent of non-muscle invasive cancers, respectively.
The rate of recurrence of non-muscle invasive bladder cancer surpasses that of all other cancers , and the majority of patients will experience a recurrence. Management of recurrent disease is, therefore, a critical concern in patients with non-muscle invasive bladder cancer. Determining optimal therapy, however, is complicated by the heterogeneity of disease in these patients.
Even with optimal treatment, patients with non-muscle invasive disease are at high risk of recurrence with further non-muscle invasive disease or of progression to more advanced disease. The management of recurrent or persistent non-muscle invasive disease is discussed in this topic.
The initial management and follow-up of patients with non-muscle invasive bladder cancer is discussed separately. (See "Treatment of primary non-muscle invasive urothelial bladder cancer".)
RISK OF RECURRENCE
Data on the risk of recurrence and progression in patients with non-muscle invasive bladder cancer are derived from large series that included patients with both primary and recurrent disease. These issues are discussed separately. (See "Treatment of primary non-muscle invasive urothelial bladder cancer", section on 'Risk stratification'.)
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- RISK OF RECURRENCE
- DEFINITION OF RECURRENCE STATES
- Recurrence without prior adjuvant intravesical therapy
- Recurrence after prior adjuvant intravesical therapy
- DIAGNOSIS OF RECURRENCE
- TREATMENT OF RECURRENT DISEASE
- Transurethral resection of bladder tumor
- - Single-dose perioperative chemotherapy
- No prior adjuvant intravesical therapy
- Salvage intravesical therapy
- - Intravesical BCG
- - Other salvage intravesical regimens
- BCG plus interferon alpha-2b
- Salvage chemohyperthermia
- Electromotive administration of mitomycin
- Experimental intravesical therapies
- Checkpoint inhibition immunotherapy
- Radical cystectomy
- Radiation therapy
- SUMMARY AND RECOMMENDATIONS