Bladder Cancer Recurrence: Causes, Risks, and Prevention Tips
By Dr. Anup Ramani
Bladder cancer, though treatable, is known for its high recurrence rate. Even after successful initial treatment, many patients face the challenge of the cancer returning. Understanding the causes, identifying risk factors, and taking preventive measures can significantly improve outcomes for individuals affected by bladder cancer. This article explores the causes of recurrence, the risks involved, and effective prevention tips to help manage and reduce the chances of bladder cancer coming back.
What Causes Bladder Cancer to Recur?
Bladder cancer recurrence happens when remaining cancer cells that were not eliminated during the initial treatment begin to grow again. Even after a seemingly successful treatment, a few microscopic cancer cells may survive and cause a new tumor to form. The reasons for recurrence can include:
- Incomplete removal of cancerous cells: If any cancer cells are left behind after surgery or other treatments, they can trigger a recurrence.
- Cancer type and stage: Certain types of bladder cancer, particularly high-risk non-muscle invasive bladder cancer (NMIBC), are more likely to recur. Muscle-invasive bladder cancer (MIBC), although less common, tends to be more aggressive and has a higher recurrence rate.
- Cellular resistance: In some cases, cancer cells may develop resistance to treatment methods like chemotherapy or immunotherapy, allowing them to grow back.
What Are the Risk Factors for Bladder Cancer Recurrence?
Several risk factors increase the likelihood of bladder cancer coming back:
Type and Stage of Cancer
- High-risk NMIBC: Non-muscle invasive bladder cancer, especially those that are high-grade or large in size, have a significantly higher risk of recurrence compared to low-risk types.
- Muscle-invasive bladder cancer (MIBC): This more aggressive form of bladder cancer has a higher chance of recurrence after treatment.
Incomplete Initial Treatment
- Residual cancer cells: If not all cancer cells are removed during initial surgery or treatment, they can cause recurrence.
Lifestyle Factors
- Smoking: Smoking is one of the most significant risk factors for both the initial development and the recurrence of bladder cancer. Cigarette toxins are excreted through the bladder, increasing the risk of cancer returning.
Tumor Characteristics
- Larger tumors: Tumors that are larger at the time of diagnosis are more likely to come back.
- Multiple tumors: The presence of multiple tumors in the bladder increases the risk of recurrence.
- High histological grade: High-grade tumors (those that appear more abnormal under the microscope) tend to recur more often than low-grade tumors.
Chronic Conditions
- Chronic bladder irritation or infections: Conditions like interstitial cystitis or repeated urinary tract infections (UTIs) can cause inflammation, which may increase the likelihood of cancer returning.
How Can Bladder Cancer Recurrence Be Prevented?
Although complete prevention of recurrence isn’t always possible, there are several strategies that can help reduce the risk of bladder cancer returning and aid in early detection.
Follow-up Appointments and Surveillance
Regular monitoring after bladder cancer treatment is crucial for detecting recurrence as early as possible. Key surveillance methods include:
- Cystoscopy: A procedure where a tube with a camera is inserted into the bladder to visually inspect for any new or returning tumors.
- Urine Cytology: A test that examines urine for cancer cells, which can help in early detection of recurrence.
- Imaging Tests: Techniques like CT scans or ultrasounds are used to check for signs of cancer spread or recurrence.
Regular follow-ups, typically every three to six months after initial treatment, are recommended to ensure that recurrence is detected early.
What Lifestyle Modifications Can Help Prevent Bladder Cancer Recurrence?
Adopting healthy habits can play an essential role in reducing the likelihood of recurrence.
Quit Smoking
- Smoking cessation is one of the most critical changes a person can make to reduce their risk of bladder cancer recurrence. Quitting tobacco significantly lowers the risk of cancer returning, as smoking is a major cause of both initial and recurrent bladder cancer.
Healthy Diet
- Eating a balanced diet that includes plenty of fruits, vegetables, and whole grains can help boost the immune system, improve overall health, and potentially reduce cancer risk.
Stay Hydrated
- Drinking plenty of fluids, especially water, helps flush out toxins from the bladder and keeps the urinary system functioning well, reducing the likelihood of carcinogens accumulating in the bladder.
Limit Exposure to Harmful Chemicals
- Occupational exposure to harmful chemicals, such as trichloroethylene (used in industrial settings), can increase the risk of bladder cancer. Workers in industries like textiles, rubber, or paint should follow safety protocols and wear protective gear.
Regular Exercise
- Regular physical activity improves overall health, supports immune function, and may enhance the body’s ability to fight off cancer cells. Exercise also helps maintain a healthy weight, which is essential in reducing the risk of cancer recurrence.
What Our Patients Are Saying
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Are There Any Intravesical Therapies for Bladder Cancer Recurrence Prevention?
For patients with non-muscle invasive bladder cancer (NMIBC), there are effective treatments aimed at preventing recurrence.
- Intravesical Immunotherapy: Bacillus Calmette-Guérin (BCG) therapy is a standard treatment for high-risk NMIBC. It involves injecting the immunotherapy directly into the bladder to stimulate the immune system to attack cancer cells.
- Intravesical Chemotherapy: In some cases, chemotherapy may be delivered directly into the bladder to target residual cancer cells, lowering the risk of recurrence.
These therapies have proven highly effective in reducing recurrence rates, particularly for high-risk bladder cancer.
Why is Personalized Treatment and Surveillance Important for Bladder Cancer Patients?
Each bladder cancer patient is unique, and the risk of recurrence can vary based on various factors such as the type and stage of the cancer, overall health, and lifestyle habits. A personalized treatment plan developed with the help of a healthcare team ensures the most appropriate approach for each individual. Key components of a personalized plan include:
- Tailored follow-up schedules: Based on the patient’s risk factors and cancer characteristics, follow-up schedules can be adjusted for closer monitoring.
- Customized therapies: Specific treatments, such as BCG therapy or chemotherapy, may be recommended based on the patient’s specific needs.
By working closely with their healthcare team, patients can ensure that their treatment plan is continually adapted to manage recurrence risk and improve overall health.
Can Bladder Cancer Recurrence Happen Years After Treatment?
Yes, bladder cancer can recur even many years after successful initial treatment. In some cases, recurrence may occur after five years or more. That’s why long-term follow-up is crucial, as late recurrence can still happen despite a long period of remission.
Regular check-ups and early detection are critical for managing long-term recurrence and improving survival rates.
What Should I Do If I Experience New Symptoms After Bladder Cancer Treatment?
If you experience any new or concerning symptoms after bladder cancer treatment, it’s important to speak with your doctor immediately. Common symptoms of recurrence include:
- Blood in the urine (hematuria)
- Frequent or urgent need to urinate
- Painful urination
- Pelvic or lower abdominal pain
Early detection of recurrence often leads to better treatment outcomes. Don’t ignore any unusual symptoms, and make sure to keep all follow-up appointments as scheduled.
Conclusion
Bladder cancer recurrence is a significant concern for many patients, but understanding the causes, recognizing risk factors, and taking preventive measures can make a big difference. Key strategies like smoking cessation, healthy eating, regular exercise, and consistent follow-up care are essential in reducing the risk of recurrence. With effective intravesical therapies and personalized treatment, the chances of long-term survival and a better quality of life can be greatly improved. Early detection remains the cornerstone of successful treatment for bladder cancer recurrence.
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PARTIAL PENECTOMY
- Partial penectomy is done in cases where glans and distal penis is involved with carcinoma.
- Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
- Patients who develop stones in the kidney or ureter, often experience severe pain.
- This condition usually needs a procedure to remove the kidney stones.
- This procedure is called ureteroscopy and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
- The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
- The procedure takes about 40-50 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is one night and patient is discharged the next day after removal of the catheter.
- Patient has to come back after six weeks to remove the stent in the kidney.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
- Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
- This procedure is called TURP and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
- The overgrown prostate is dissolved with a laser bloodlessly.
- The procedure takes about 40 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR
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Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
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Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.
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The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
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Dr. Ramani then sits in the controlling console to perform the surgery.
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On an average, a robotic adrenalectomy takes one hour.
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The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
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A urine catheter and bag to drain the bladder is inserted during surgery.
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A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.
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Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
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The drain pipe, if kept, is removed in the room on day 2 after surgery.
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The catheter is removed on day two after surgery.
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Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).
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Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.
Heavy activities like running, weight lifting can be resumed after a month
FOLLOW UP AFTER SURGERY
Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
Local patients usually meet Dr. Ramani after two weeks to discuss report.Outstation patients are counselled on a phone consultation.
ROBOTIC SURGERY FOR BLADDER CANCER
- Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
- Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
- Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the new bladder is inserted during surgery.
- Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
- The drain pipes are removed in the room on day 3-5 after surgery.
- Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY
Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.
Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.
Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.
If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.
ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
- Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
- relatively easier but still requires significant experience to consistently deliver results.
- Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the bladder is inserted during surgery.
- A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
- The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
- Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self- sufficient.
- They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 2-3 weeks of surgery.
- Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
- Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
- Local patients usually meet Dr. Ramani after two weeks to discuss report.
- Outstation patients are counselled on a phone consultation.