BC Flashcards
Risk factors for bladder cancer
Smoking
Occupational hazards
Pelvic irradiation
Cyclophosphamide
Pioglitazone
How?
Nicotine and nephtalamine , dyes etc , acetylised in Liver by N acetyl transferase enzyme
Slow Acetylators have 40%increased risk of bladder cancer
Prognostic features for recurrence/progression (EORTC)
Stage
Grade
Size >3 cm
Multifocality
Rate of recurrence
CIS
Hematuria and prevalence of cancer evidence
Khadra
Prevalence of cancer in VH : 25%
NHV : 9.5%
Edward’s
Cancer prevalence increased with age and presence of visible haematuria and in men
Ultrasound is good at detecting upper tract tumours (sensitivity: 98.3% for RCC and 76.9% for UTUC)
IDENTIFY study
Visible haematuria is the strongest risk factor for urothelial cancer, followed by age, smoking and male sex
MMC evidence
Sylvister
SI MMC post TURBT NNT 8.5 , ARR 14%,
RRR 39%
ODMIT-C
SI MMC after NephroU
NNT 9 , ARR 11%, RRR 40 %
NICE adjuncts to cystoscopy
PDD : HAL 1 hr prior , taken up by urothelium, change light to blue , abnormal cells will flurecene pink- because it converts into protoporphyrin as tumor cells has HB
Improved detection, improved time to recurrence but not recurrence rates
Not cost effective (photo study)
NBI: filters all lights but blue and green , tumor cells are vascular , green Normal , brown , blue Bad
Urine cytology: not first void , whole voided sample if possible , mid morning, sent to lab asap. Low sens /spec for low grade ~15% , high sens 80% , spec 80-90% for high grade. Paris system.
Used in follow up of high risk .
Urine biomarkers :
FISH ( urovision)
BTA
Expert
Poor prognostic factors for NMIBC
CUETO study
Female
Old Age
CIS in prostatic urethra
Tumor size
Concurrent CIS
LVI
Variant histology
Recurrence at 3 months
Residual disease at restaging TURBT
Viva 1
71 yr female VH , LUTS
Where to see?
What investigations?
Cysto - bladder tumor 3 cm
What to do next?
How to consent?
Histology > T1 HG , no CIS
Importance and NH of T1HG ?
What’s next step after MDT?
Re resection no upstage , no CIS .
Plan?
Received 6 BCG , started maintenance, had @ 3months , 6th month and 12 months. Now has severe urgency and bad Qol- whats your plan?
Pt PMHx : narrow angle glucoma
What’s BCG , what protocol?
What is your managerial input in case of national BCG shortage?
