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9 - Clinical follow-up of bladder cancer

Published online by Cambridge University Press:  25 August 2009

By
Alan Thompson  and
Sarb Sandhu
Edited by
David MacVicar
David MacVicar
Affiliation:
Royal Marsden Hospital
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Summary

Superficial bladder cancer

Cystoscopic follow-up

There is no doubt that cystoscopy remains the gold standard of follow-up for patients who have undergone a transurethral resection (TUR) of a superficial bladder cancer. The majority will undergo a flexible cystoscopy, which obviates the need for a general or spinal anesthetic and which is very well tolerated. A flexible cystoscopy allows the regular inspection of the urethra and the whole bladder with a low morbidity and low cost. With modern videocystoscopes and experience, even very small recurrences can be readily detected. The interpretation of flat mucosal lesions is, however, difficult.

The first check cystoscopy is performed three months following the initial TUR apart from in those cases where there is a question over the grade (G2 or G3) or when there is uncertainity as to the depth of invasion of the tumor. In such cases, an early repeat resection or biopsy is made at the site of the initial tumor (4–6 weeks) [1]. However, although some doubt that the repeat early TUR has any effect on the subsequent outcome of these cases, it has been shown to reduce recurrences and improve prognosis. Indeed, there is a 10% chance that a G3TaT1 tumor has been understaged and is therefore a muscle invasive tumor [1–3]. The treatment of muscle invasive bladder tumors is completely different to that of superficial bladder tumors (see Chapter 6).

There are two main questions regarding the follow-up of patients after treatment for superficial bladder cancer. These are

  1. At what sort of frequency should follow-up occur?

  2. […]

Type
Chapter
Information
Carcinoma of the Bladder , pp. 137 - 146
Publisher: Cambridge University Press
Print publication year: 2008

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