bladder%20cancer
BLADDER CANCER

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-month intervals for the first 2 years, then at increasing intervals thereafter as appropriate
    • If negative, subsequent cystoscopy & cytology should be repeated every 3 months for a period of 2 years, & every 6 months thereafter until 5 years
    • Imaging of the upper tract should be done every 1 to 2 years
  • During follow-up in patients w/ positive cytology & no visible tumor in the bladder, selective mapping or random biopsies or biopsies w/ photodynamic diagnosis & investigation of extravesical locations including transurethral resection of the prostate (TURP) & cytology of the upper tract are recommended

Muscle-invasive Bladder Cancer

  • After a radical cystectomy follow-up should include:
    • Urine cytology, liver function tests, creatinine & electrolytes every 6-12 months for 2 years & then as clinically indicated
    • Imaging of the chest, upper tracts, abdomen & pelvis should be conducted every 3-6 months for 2 years 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 months, 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-month intervals for the first 2 years, then at increasing intervals according to clinical discretion
  • After radical radiotherapy the following is recommended:
    • Rigid cystoscopy 3 months after radiotherapy has been completed, followed by either rigid or flexible cystoscopy:
      • Every 3 months for the first 2 years then
      • Every 6 months for the next 2 years then
      • Every year thereafter, according to clinical judgment & the patient’s preference
    • Upper tract imaging every year for 5 years
    • Monitoring for local & distant recurrence using CT of the abdomen, pelvis & chest, carried out w/ other planned CT imaging if possible 6, 12, & 24 months after radical radiotherapy has finished
  • Most Asian centers have a check using cystoscopy at 3 months 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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