From the Research
Surveillance after urachal cancer should include regular follow-up with imaging studies and laboratory tests for at least 5 years post-treatment, with a focus on detecting recurrence and metastasis early to improve morbidity, mortality, and quality of life outcomes. I recommend CT scans of the abdomen and pelvis every 3-6 months for the first 2 years, then every 6-12 months for years 3-5, as supported by the most recent study 1. Chest imaging should be performed annually to monitor for pulmonary metastases, given the tendency of urachal cancer to metastasize to the lungs 2. Laboratory tests should include urinalysis, urine cytology, and serum markers such as CEA, CA 19-9, and CA-125 every 3-6 months initially, then annually after 2 years, with CEA levels being particularly helpful for therapy monitoring 1. Cystoscopy may be performed every 6-12 months if there was bladder involvement, considering the high recurrence rate and aggressive nature of urachal cancer 3. This surveillance schedule is crucial because urachal cancer has a high recurrence rate, with most recurrences occurring within the first 2 years but some appearing as late as 5 years post-treatment, emphasizing the need for thorough and prolonged monitoring 4. Patients should be educated about potential symptoms of recurrence, including hematuria, abdominal pain, or unexplained weight loss, which should prompt immediate medical evaluation even between scheduled surveillance visits, to ensure timely intervention and improve outcomes 5.
Some key points to consider in the surveillance protocol include:
- The use of FDG-PET/CT for detecting local recurrences and metastases, especially during follow-up, as it may provide additional information compared to standard CT scans 2
- The importance of individualized treatment decisions, given the rarity of urachal cancer and the lack of standardized guidelines, highlighting the need for a precision oncology approach 1
- The potential benefits of molecularly informed therapies, such as targeted treatments and checkpoint inhibitors, in improving outcomes for patients with urachal cancer, although more research is needed to fully establish their efficacy 1