Urachal cancer is a rare form of bladder cancer that arises from the urachus, a vestigial musculofibrous band that extends from the dome of the bladder to the umbilicus. Urachal cancer often presents at an advanced stage and has a dismal prognosis. We present a case of a woman with urachal cancer that recurred rapidly post-partial cystectomy. The patient was treated with chemotherapy regimens, including an oral antiangiogenic drug as part of a clinical trial. Our case illustrates the aggressive nature of this disease, the difficulty in accessing drugs for the treatment of rare cancers and the lack of late-stage clinical trials to help guide therapeutic decisions.