NCCN Guidelines for Patients® | Bladder Cancer

36 NCCN Guidelines for Patients ® : Bladder Cancer, 2019 4  Non–muscle-invasive bladder cancer Follow-up care Follow-up care When you have finished treatment, the next phase of cancer care will begin. This is the surveillance phase. During this time, it is important to have testing to monitor for the return of cancer. The specific tests you should have—and how often you should have them—are guided by the risk of the cancer returning. NCCN experts use a system developed by the American Urological Association (AUA) to determine whether there is a low, intermediate (average), or high risk that cancer will return. See Guide 3 for definitions of the three risk levels. Ask your treatment team to help you determine whether you are at low, intermediate, or high risk of the cancer coming back. See Guide 4 for the recommended follow-up tests according to risk level. Guide 3. Risk level definitions for non–muscle-invasive disease Risk level Description Low risk • You have one slow-growing Ta tumor that is 3 cm (about the size of a strawberry) or smaller • You have a tumor that is unlikely to turn into bladder cancer, called a papillary urothelial neoplasm of low malignant potential (PUNLMP) Medium risk • You have a slow-growing Ta tumor that came back during the first year after treatment • You have one slow-growing Ta tumor larger than 3 cm (about the size of a strawberry) • You have a slow-growing multifocal Ta tumor • You have a fast-growing Ta tumor that is 3 cm (about the size of a strawberry) or smaller • You have a slow-growing T1 tumor High risk • You have a fast-growing T1 tumor • You have a high-grade Ta tumor that came back after treatment • You have a high-grade Ta tumor bigger than 3 cm (about the size of a strawberry) or a multifocal Ta tumor • There is carcinoma in situ • You have a high-grade tumor and BCG therapy didn’t work for you • You have a rare tumor type • There are tumor cells in the blood or lymph vessels outside of the main tumor • There are high-grade cancer cells in the part of the urethra that passes through the prostate (only applies to men)

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