The standard treatment for superficial bladder cancer is transurethral resection of bladder tumor (TURBT), while some patients undergo partial bladder resection because of the location and size of the tumor, and a few patients undergo total bladder resection because of the high malignancy of the tumor (e.g., multiple T1G3, combined with carcinoma in situ, recurrent).
The first two treatment methods preserve the bladder, but also lay the hidden danger for bladder tumor recurrence, which may develop into muscle-invasive bladder cancer or even life-threatening if not detected and treated in time. Therefore, standardized and close follow-up reviews must be performed after superficial bladder cancer surgery.
Common components of the review include cystoscopy, urinary exfoliation cytology and pelvic imaging. Because 50-70% of bladder cancer recurrence will occur after cystectomy, and most of the recurrences (about 80%) occur within 2 years after surgery, the review is more frequent within 2 years, every 3 months; every 6 months in 3-4 years, and once a year after that.
Cystoscopy is invasive and invasive, and medical doctors have been trying to find new non-invasive alternatives to cystoscopy, which until now was the gold standard for diagnosing bladder cancer. A rigid cystoscopy is impossible to be too fine because of the need to balance the need for clear vision and microscopic manipulation such as biopsy, so it causes great pain to patients (especially men). Many patients are frightened when they hear that they need to undergo cystoscopy. However, the advent of soft cystoscopy has greatly alleviated this situation, significantly reducing the pain of cystoscopy and making pain in the urethra and hematuria rare after the examination. Moreover, the flexible scope is superior to the rigid cystoscope in both the size of the sheath and the angle of observation, greatly reducing pain and the possibility of missed diagnoses without the dead space of cystoscopic observation.
Urine exfoliative cytology looks for cancer cells in the urine, and if cancer cells are found, they may originate from the renal pelvis, ureter or bladder and urethra. For postoperative patients with bladder cancer, the source bladder is the most likely, suggesting tumor recurrence or the presence of carcinoma in situ. It can detect lesions that are not obvious on cystoscopic observation, but is less sensitive.
CT or MR of the bladder,can evaluate the bladder and surrounding tissues. We have seen some cases where the tumor is not visible in the bladder, but the tumor grows outwardly recurrently, which can easily delay the disease. Therefore, it is recommended to perform CT examination once in 6-12 months to rule out this possibility.
As long as recurrent bladder tumors are detected early, most of them can still be treated by electrodesiccation and continue with conventional adjuvant therapy such as bladder irrigation. If not reviewed regularly, by the time there are symptoms, the chance of bladder preservation surgery may have been lost and even metastasis may occur.