Bladder cancer is a heterogenous neoplasm that ranges from non-life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors that often metastasizes at the presentation.

It is the most common cancer involving the urinary system and it is the 11th most commonly diagnosed in the world.

Microscopic or gross painless hematuria is the most common presenting complaint.

Follow Up

Non-muscle-invasive bladder cancer

  • After TURBT, first cystoscopy should be done after 3 mths beccause it is an important prognostic indicator for recurrence & progression in patients w/ Ta, T1 tumors & CIS
  • For low-risk patients w/ Ta tumors, cystoscopy should be done at 3 mths
    • If negative, subsequent cystoscopy is suggested 9 mths later, then yrly for 5 yrs
  • Intermediate-risk patients w/ Ta tumors should have an in-between follow-up scheme using cystoscopy & cytology according to personal & subjective factors
    • Cystoscopic follow-up at 3, 9, & 18 mths & once a year thereafter is suggested
  • Patients w/ high-risk tumors should undergo cystoscopy & urinary cytology at 3 mths
    • If negative, subsequent cystoscopy & cytology should be repeated every 3 mths for a period of 2 yrs, & every 6 mths thereafter until 5 yrs
  • During follow-up in patients w/ positive cytology & no visible tumor in the bladder, random biopsies or biopsies w/ photodynamic diagnosis & investigation of extravesical locations are recommended

Muscle-invasive bladder cancer

  • After a radical cystectomy follow-up should include:
    • Urine cytology, liver function tests, creatinine & electrolytes every 6-12 mths for 2 yrs & then as clinically indicated
    • Imaging of the chest, upper tracts, abdomen & pelvis should be conducted every 3-6 mths for 2 yrs based on the risk of recurrence & then as clinically indicated
    • Vitamin B12 deficiency should be monitored annually if a continent urinary diversion was created
    • Consider urethral wash cytology every 6-12 mths, particularly if Tis was found within the bladder or prostatic urethra
  • After a partial cystectomy follow-up is similar to that for a radical cystectomy, w/ the addition of monitoring for relapse in the bladder by serial cytologic examinations & cystoscopies at 3- to 6-mth intervals for the first 2 yrs, then at increasing intervals according to clinical discretion
  • After radical radiotherapy the following is recommended:
    • Rigid cystoscopy 3 mths after radiotherapy has been completed, followed by either rigid or flexible cystoscopy:
      • every 3 months for the first 2 yrs then
      • every 6 months for the next 2 yrs then
      • every year thereafter, according to clinical judgment & the patient’s preference
    • Upper tract imaging every year for 5 yrs
    • Monitoring for local & distant recurrence using CT of the abdomen, pelvis & chest, carried out w/ other planned CT imaging if possible 6, 12, & 24 mths after radical radiotherapy has finished
  • Most Asian centers have a check using cystoscopy at 3 mths after adjuvant intravesical treatment, then increasing intervals as appropriate
    • Urinary urothelial markers (eg nuclear matrix protein 22 & bladder tumor antigen) can be used in Asian countries
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