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Management of recurrent or persistent non-muscle invasive bladder cancer

Peter Black, MD, FACS, FRCSC
Wassim Kassouf, MD, CM, FRCS
Section Editor
Seth P Lerner, MD
Deputy Editor
Michael E Ross, MD


Approximately 70 percent of new urothelial (formerly called transitional cell) bladder cancer cases are classified as non-muscle invasive [1]. 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 [2], 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".)


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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Literature review current through: Nov 2017. | This topic last updated: Aug 28, 2017.
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