Editing Upper Urinary Tract Urothelial Cancer (section)

===== CUA =====

*'''See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6114151/table/t6-cuaj-8-243/ Table] from [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6114151/ 2018 CUA Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma]'''
*'''Bladder'''
** '''Should be assessed with cytology and cystoscopy in all patients at months 3, 6, 12, 18, 24 and annually thereafter for up to 10 years of recurrence-free survival'''
* '''<span style="color:#ff0000">Ipsilateral upper tract</span>'''
** '''<span style="color:#ff0000">Should be assessed by URS and selective cytology or biopsy in all patients following nephron-sparing procedures at months 3, 6, 12, 18, 24 and annually thereafter up to 10 years of recurrence-free survival</span>'''
*** '''<span style="color:#ff0000">Computed tomography urography (CTU) and retrograde pyelography lacks sensitivity</span>'''
* '''Extra-urinary sites'''
** '''<span style="color:#ff0000">Routine blood work should include:</span>'''
*** '''<span style="color:#ff0000">Renal function tests</span>'''
*** '''<span style="color:#ff0000">Metabolic panel, including liver function tests, calcium and alkaline phosphatase</span>'''
** '''<span style="color:#ff0000">To assess for local, contralateral and distant metastases</span>''' in patients after nephroureterectomy or nephron-sparing procedures, '''<span style="color:#ff0000">imaging of the abdomen and pelvis with CTU is recommended</span>'''
*** MRI or US may be substituted for CTU in patients with contraindications to CTU
*** '''CXR is recommended to assess for lung metastases'''
*** Bone scan is indicated in the presence of bone pain, elevated calcium or elevated alkaline phosphatase to assess for bone metastases
* '''Lack of evidence for an optimal duration of surveillance; recommended approach:'''
** '''High-grade, pT≥2 or pN+: lifelong annual surveillance with history, physical examination, blood work, urine cytology and abdominal/chest imaging'''
** '''Low-grade, pT<2 pN0/x: annual cystoscopy and ipsilateral ureteroscopy (following nephron-sparing procedures) may be omitted after 10 years of recurrence-free survival; after 10 years of recurrence-free survival, patients with may be discharged from annual surveillance'''