Bladder cancer

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

See the Ayrshire & Arran urgent cancer suspected pathway: bladder - multidisciplinary

Superficial bladder cancer

Low risk: 

  • First check LA cystoscopy at 3 months, if recurrence free, check cystoscopy at 12 months
  • Consider discharging after 12 months of disease-free follow-up
  • No indication for routine upper tract imaging.

Intermediate risk:

  • Offer 6 week course intravesical mitomycin C
  • Check LA cystoscopy at 3 months, 9 months and 18 months
  • Annual check cystoscopy thereafter
  • Consider discharging after 5 years of disease-free follow-up
  • No indication for routine upper tract imaging.

High risk:

  • Stage with CT urogram and chest
  • Consider re-resect within 6 weeks
  • Offer immediate cystectomy or intravesical Bacillus Calmette Guerin (BCG) induction and maintenance
    • Check cystoscopy at 3 months and then every 3-6 months for the first 2 years
  • If no recurrence, check GA/LA cystoscopy every 6 months for the next 2 years. Annual check cystoscopy from year 5 onwards.

All patients will have direct contact details for CNS team should they have any concerns between visits.

Post-radical cystectomy

Muscle invasive bladder cancer (MIBC) routine oncologic follow-up after radical cystectomy or radical chemo radiotherapy for MIBC is controversial and may be influenced by the feasibility and/or acceptability of further treatment options such as palliative chemotherapy or salvage cystectomy.

(Table below best viewed in landscape)

  6 months 12 months 24 months 36 months 48 months 60 months Annually year 5-10
Bloods Yes Yes Yes Yes Yes Yes  
Urethroscopy   Yes Yes Yes Yes Yes  
CT scan CT Chest/Abdomen/Pelvis (C/A/P) CT C/A/P CT C/A/P CT urogram + chest CT urogram + chest CT urogram + chest  
              ultrasound scan

Adapted from WOSCAN guidelines 20151 

Post-radical radiotherapy

In patients where salvage cystectomy would be considered:

  • Cystoscopy 3 months after radiotherapy is completed
  • If residual disease resected at 3 months to go back to MDT for discussion.

(Table below is best viewed in landscape)

  Year 1-2 Year 2-4 Year 4 onwards
Check flexible cystoscopy 3 monthly 6 monthly annually
CT CAP 6 monthly    
CT urogram and chest   annually annually

Adapted from WOSCAN guidelines 20151.All patients will have direct contact details for CNS team should they have any concerns between visits.

References

1. West of Scotland Cancer Network. Urological Cancers Managed Clinical Network. Bladder cancer regional follow-up guidelines. v2.1. November 2015. Available from: https://www.woscan.scot.nhs.uk/wp-content/uploads/URO-Bladder-Follow-up-Regional-Guideline-v2.1-November-2015.pdf