UROLOGICAL CANCERS

RENAL CANCER

Clinical Guidelines for follow-up

Curative Nephrectomy:
All T stages – 4 to 6 weeks outpatient appointment; physical exam;
haemaglobin; creatinine.
T1 T2 – every six months for three years. Every year for three to five years
(exam, CXR). Optional – renal ultrasound and alkaline phos.
T3 T4 – Every six months for three years. Every year for three years (exam;
CXR). Optional – Retro abdominal CT

Partial Nephrectomy:
As for T3 T4. Three months (CT and U/S) and then at six months CT/MRI.

Imaging Guidelines for Follow-up

Non-surgical Patient
Imaging suspected renal cancer that is Ultrasound – 4-6 months or as clinically
under surveillance indicated.

If decision is made to proceed to CT – as above

definitive treatment
Annual U/S, annual CT (staggered by
Indeterminate solid lesion or type 3 cyst 6mths) up to 2 years if no change
Post nephrectomy CXR 6mthly first year then yearly (for
Renal cell cancer – stage T1 or T2 2yrs). At discharge U/S remaining kidney

Renal cell cancer – stage T3 or T4
Post partial nephrectomy
New onset pain
clinically suspected recurrence
CXR 6mthly first year then yearly (for
5yrs)
CT 4mths + contemporaneous U/S with
annual U/S and CXR thereafter
straight to CT
CT is the investigation of choice
UPPER TRACT CANCER

Clinical Guidelines for follow-up

No current guideline for SCN

Imaging Guidelines for Follow-up

No current guideline for SCN

TERATOMA & SEMINOMA

Guidelines for follow-up from the Royal Marsden (specialist MDT for
SCN)

Non Seminoma Germ Cell Tumour: Stage 1:Surveillance

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x x x x x
Markers x x x x x x x x x x x x
CXR x x x x x x x
CT abdo x x

Year 2 (late effects)*

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x x
Markers x x x x
CXR x x x x
CT abdo x

Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x
Markers x x x
CXR x x x
CT

Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x x
CT
Year 5
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x x
CT
Discharge after 5 years
Follow up after adjuvant chemotherapy
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x x x
Markers x x x x x
CXR x x x
CT abdo x

Year 2 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x
al
Marke x x x
rs
CXR x
CT

Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT
 Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT

Year 5 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT
Discharge after 5 years

Seminoma Stage 1: Surveillance

CT scans of abdomen only unless pelvis at high risk
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x x
al
Marke x x x x
rs
CXR x x
CT x x
Year 2 (late effects)*
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x x
al
Marke x x x x
rs
CXR x x
CT x x
Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x
al
Marke x x x
rs
CXR x
CT x
Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT x
 Year 5
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x
CT x

Follow up yearly until 10 years: no CXR after 5 years

Seminoma Stage I: Single agent Carboplatin
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x x x
al
Marke x x x x x
rs
CXR x x
CT x
Year 2 late effects(*)
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x
al
Marke x x x
rs
CXR x
CT x
Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT
Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT
 Year 5 late effects(*)
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT x

Annual follow up until 10 years, clinical and markers

Seminoma Follow up: Para-aortic RT
CT of pelvis only unless clinical reason to scan abdomen
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x x
Markers x x x x
CXR x x x x
CT pelvis (x)

Year 2 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x
Markers x x x
CXR x x x
CT pelvis (x)

Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x
CT
Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x
CT

Year 5 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x
CT pelvis (x)
Discharge after 5 years

Seminoma: Stage IIa/b Follow up after carboplatin and

radiotherapy
CT scans should be abdomen/pelvis
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x x
al
Marke x x x x
rs
CXR x x x
CT x x

Year 2 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x
al
Marke x x x
rs
CXR x
CT x

Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT

Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT

Year 5 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT x

Annual follow up until 10 years, clinical and markers

Metastatic NSGCT and Seminoma stage IIc-IV Post chemotherapy
CT until CR with or without surgery, frequency determined by MDT
Year 1
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x x x x x
al
Marke x x x x x x
rs
CXR x x x
CT

Year 2 late effects(*)

Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x x
Markers x x x
CXR x x x

Year 3
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x

Year 4
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinical x x
Markers x x
CXR x
Year 5 late effects(*)
Month 1 2 3 4 5 6 7 8 9 10 11 12
Clinic x x
al
Marke x x
rs
CXR x
CT x

Discharge Seminoma patients at 5 years. For NSGCT patients

follow up annually until 10 years and then bi-annually. Stop
performing CXR’s at 10 years

Imaging Guidelines for Follow-up

Teratoma and Seminoma
TERATOMA Stage 1 Monthly clinical follow up with markers
(no lymphadenopathy) and CXR for 12 months and then bi-
monthly to 24 months

CT( +/- contrast at radiology department

discretion) – 3, 6, 9,12, 24 months from
orchidectomy. CXR omitted on CT month
TERATOMA post treatment Enhanced CT chest and abdomen on
(chemotherapy) completion of chemotherapy, subsequent
scanning at intervals determined by RMH
MDT until insignificant (surgical option
not indicated)
SEMINOMA following para-aortic strip Enhanced CT (or non-enhanced at
radiotherapy radiology discretion) – thorax, abdomen,
pelvis at 12 months post treatment
SEMINOMA following carboplatin Enhanced CT (or non-enhanced at
therapy radiology discretion) – thorax, abdomen,
pelvis at 6 and 12 months post treatment
(under review)
PROSTATE CANCER
Clinical Guidelines for follow-up

No current guideline for SCN

PSA

Imaging Guidelines for Follow-up

No routine imaging

ADRENAL GLAND CANCER

Clinical Guidelines for follow-up

No current guideline for SCN.

Imaging Guidelines for Follow-up

No current guideline for SCN.

PENILE CANCER
Clinical Guidelines for follow-up from the Specialist MDT for the SCN (St
George’s)

Patients who have completed initial treatment and staging investigations will
be given a follow-up plan, copied to themselves, the referring Consultant and
the General Practitioner, which includes surveillance for a minimum of three
years in all patients and in selected cases radiotherapy and/or chemotherapy
and/or further surgery may be required.

For surveillance purposes patients are broadly categorised into low,

intermediate and high risk. All high risk patients will be reviewed for the
duration of their follow-up at St George's Hospital. Patients with low or
intermediate risk status may wish to be followed up locally at their referring
hospital and a detailed plan will be given to that patient after consultation with
the consultant at the local hospital. Experience to date would suggest that the
vast majority of patients would prefer to be followed up at St George's
Hospital for the duration of their follow up regardless of their risk status even
when offered the option of being seen at their local hospital.
Imaging studies are generally organised for patients who are travelling some
distance to be done on the same day as their clinic visit to minimise the
number of journeys to and from St George's.

Patients who require radiotherapy and/or chemotherapy will be referred

directly to the appropriate Cancer Centre with the recommendation of the
supranetwork MDT. Our medical oncologists and radiation oncologists have
established links with appropriately interested consultant colleagues within
these Cancer Centres in order to streamline referral.

BLADDER CANCER
Clinical Guidelines for follow-up

Yet to be finalised by the Tumour Group.

Review post-radical treatment and 3-6 monthly for two years then annually to
5 years.
Plan to develop patient initiated follow-up as an alternative (not currently
available).

Imaging Guidelines for Follow-up

Post cystectomy
3-6mths conduitogram

**EUA guidelines 6.7 recommendations item 4 only**

“Mandatory investigations are those that are necessary to document a well-
functioning urinary diversion. Follow-up investigations aimed at the early detection of
tumour progression or tumour recurrence are defined as optional, and should be
performed on the basis of the individual risk profile of the patient and on the basis of
the therapeutic consequences”.

pTa Gr I No IVU, follow up flexi cystoscopy in 6 months, repeated at 6

months and then yearly if all negative up to 10 years.
pTa GrII or III IVU, follow up flexi cystoscopy in 3 months, repeated at 3
months, then 6 monthly twice, then yearly to 10 years.
pT1 Gr I-III IVU, follow up flexi-cystoscopy in 3 months, repeated at 3
months, then 6 monthly for a year, the yearly to 10 years.
These patients may need a second look cystoscopy immediately and may be
treated with intra-vesical agents depending on the decision of the MDM.
pTcis These patients can be offered immediate cystectomy, course of BCG
intra-vesically followed by further cystoscopies and biopsies and if responding
to treatment, maintenance BCG therapy which is (so far) for 5 years.
pT2-3 Any patient with a muscle infiltrating tumour may receive neo-adjuvant
chemotherapy depending on histology, renal function and tumour size.
After neo-adjuvant chemotherapy (if so treated) patients may have
radiotherapy or radical cystectomy with urinary diversion.
Patients treated with radiotherapy will need frequent and careful follow up with
cystoscopy depending on the original tumour. They also need Chest X-ray
and CT scans.
Post radical cystectomy patients need regular outpatient follow up with blood
tests, renal ultra-sound and IVU as well as chest x-rays.
Pt 4 Patients usually require palliative care from the MDM team.