Editing Muscle-invasive Bladder Cancer (2017) (section)

== Patient surveillance and follow-up ==

* '''Imaging'''
** '''Chest and cross-sectional imaging of the abdomen and pelvis (CT or MRI) should be obtained at 6-12 month intervals for 2-3 years and then may continue annually'''
*** The overall prevalence of upper tract urothelial carcinoma after cystectomy ranges from 1-6%
*** '''Imaging beyond 5 years should be based on shared decision making''' between the patient and clinician.
* '''Laboratory values and urine markers'''
** '''Following therapy for MIBC, patients should undergo laboratory assessment of electrolytes, renal function, +/- vitamin B12 at 3-6 month intervals for 2-3 years and then annually thereafter'''
*** Patients may experience metabolic derangements and declines in renal function over time associated with urinary diversion
*** '''Vitamin B12 levels should be assessed in patients with resection of > 60 cm of ileum and in those patients in whom the terminal ileum''' is utilized as there is an increased risk of deficiency and consequent neurological damage
*** '''Routine frequent CBC and liver function testing for cancer surveillance has not been validated'''
*** '''There is insufficient data to support the routine use of cytology''' or urine-based tumor markers in detection of upper tract urothelial cancers; urine collected from intestinal urinary diversion or previously irradiated bladders may contain desquamated intestinal epithelial cells or atypia due to therapy, which may lower the diagnostic specificity.
** '''In patients with a retained urethra following radical cystectomy, the urethral remnant should be monitored for recurrence'''
*** '''Urethral wash cytology''' may be a valuable tool in higher risk patients with a retained urethra. This should be considered during follow up, and patients should undergo '''physical examination of the urethra''' and '''discussion of any urethral symptoms such as urethral discharge or spotting'''.

* Patient survivorship
** Clinicians should discuss with patients how they are coping with their bladder cancer diagnosis and treatment and should recommend that patients consider participating in a cancer support group or consider receiving individual counseling.
** Clinicians should encourage bladder cancer patients to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to improve long-term health and quality of life.