Low-grade bladder tumors have a habit of coming back. That is
frustrating, but here is the key point: coming back is common
and usually not life-threatening. Low-grade tumors grow slowly
and rarely spread. The goal is to manage them with as little disruption as
possible. Below are options your doctor may discuss.
Why low-grade tumors come back
The whole lining of the bladder has been exposed to whatever led to the
first tumor, so new low-grade tumors can pop up elsewhere on that lining
over time. This is why surveillance continues even after a tumor is
removed.
Recurring does not mean the cancer is getting worse or
spreading. It usually means another low-grade tumor showed up and can be
handled much like the last one. Your doctor keeps an eye out for the less
common case where a tumor comes back at a higher grade, which would change
the plan.
Options your doctor may discuss
These are not ranked. Which fits depends on how many tumors there are, their
size, where they are, and your preferences.
Repeat removal (TURBT)
What it is
Removing the new tumor through a scope passed up the urethra, in the
operating room — the same kind of procedure that removed the first
tumor.
How it's given
Under anesthesia as a short procedure; often same-day. You may have blood
in the urine and mild burning for a few days after.
Questions to ask your doctor
Will I need a catheter afterward, and for how long?
Will a chemo instillation be given right after (see below)?
Office fulguration
What it is
Burning away a small tumor with an electric current or laser during an
office cystoscopy, using numbing medicine — no operating room or full
anesthesia.
How it's given
During a regular scope visit, for small low-grade tumors that are a good
fit. Quicker and easier to recover from than an operating-room
procedure.
Questions to ask your doctor
Are my tumors small enough for this?
What will the visit feel like?
Single-dose chemo after removal
What it is
A one-time dose of chemotherapy placed in the bladder soon after a
tumor is removed, to lower the chance a new one forms.
How it's given
Through a catheter, usually within a day of the removal procedure, held for
a set time, then drained.
Questions to ask your doctor
Is a single dose right after my removal a good fit for me?
Which medicine would be used?
Zusduri (mitomycin gel, UGN-102)
Newly approved
What it is
A form of the chemotherapy mitomycin in a special gel. It is liquid when
cool and turns to a gel at body temperature, so it stays in contact with the
bladder lining longer. It is the first medicine approved to treat certain
recurrent low-grade tumors without surgery.
How it's given
Instilled into the bladder in the office through a
catheter — no operating room.
Typical schedule
A course of once-weekly treatments for 6 weeks.
Common side effects
The most common are painful urination, urinary tract infections, and blood
in the urine; some people also have frequent urination, tiredness, or trouble
emptying the bladder.
Red flags
Inability to urinate, heavy bleeding, fever, or severe pain
— see the warning-signs panel below.
Questions to ask your doctor
Are my tumors the type this is approved to treat?
How does this compare with just removing the tumor?
What happens if a tumor remains after the course?
When to call your care team
After any of these procedures or treatments, call the office number on your
discharge paperwork right away, or seek emergency care, if you have any of
these:
A fever of 100.4°F (38°C) or higher, or shaking chills
You cannot urinate at all
Heavy bleeding or many blood clots in the urine, or
bleeding that blocks urinating
Severe belly or pelvic pain
If you have chest pain, trouble breathing, fainting, or
another life-threatening emergency, call 911.
MyUrologyCare — Low-Grade Tumors That Keep Coming Back