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Oncology > Bladder > Flashcards

Bladder Flashcards

1
Q

What is average age of bladder cancer?

A

70

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2
Q

What are major contributors to risk for bladder cancer in western world?

A 
Smoking (66%)
Occupational (20%)
-truck driving
-painting
-aluminum, leather and textile work
Cyclophosphamide
Prolonged expsoure to bladder irritants (25 x)
-indwelling foley
-cystitis
-renal calculi
-neurogenic bladder
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3
Q

What are major contributors to risk for bladder cancer in non-western world?

A

schistosomiasis

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4
Q

Current recs for screening in bladder cancer?

A

Only in symptomatic patients

- macro or microscopic hematuria (very common), irritable bladder symtpoms, flank or pelvic pain, leg swelling, DVT

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5
Q

Two categories of bladder cancer according to WHO/ISUP? Based on?

A

Low grade
High grade
unclear aplasia and architectural abnormalities

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6
Q

What are pathologic subtypes of bladder cancer?

A 
Transitional Cell Carcinoma (90%)
Squamous Cell Carcinoma (3-5% in USA, high in non-western)
Other (1-2%)
-Adenocarcinoma
-Small Cell Neuroendocrine
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7
Q

What 3 catergories of bladder cancer?

A

non-muscle invasive (superficial)
muscle invasive
metastatic

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8
Q

What should be performed prior to TURBT for non-invasive disease?

A

imaging of upper tract collecting system

CT urography, renal US or CT w/o contrast w/ retrograde pyelogram)

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9
Q

What appearance on cytoscopy pushes you to you perform CT abd/ pelvis with contrast?

A

lesions is sessile or high grade

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10
Q

What is work up for invasive bladder cancer?

A

CBC, Chemistry
Alk phos
- if elevated: Bone scan
CT C/A/P

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11
Q

staging summary for bladder cancer?

A

0-I: non invasive
II: muscle invasion
III: adipose invasion (a: microscopic, b: macroscopic)
IV: metastatic to regional nodes, or organs

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12
Q

N staging summary for bladder cancer?

A

N1: 5cm

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13
Q

What comprises non-muscle invasive tumors

A

Ta: low grade papillary
Tis: carcinoma in situ
T1: subepithelial tissue invasion

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14
Q

Why is it important to important to evaluate with CT prior to TURBT for high grade, solid or muscle invasive disease on inital cystoscopy?

A

Eval local tumor extent, abd lymph nodes, as well as synchronous and metachronous upper tract lesions (1-4%)

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15
Q

Difference between initial cystoscopy and confirmatory TURBT?

A

Cysto gives likely diagnosis based on experience and visualization whereas TURBT gives pathologic confirmation.

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16
Q

In what situations is a TUR likely insufficent for non-invasive bladder cancer?

A

Tumor > 3cm, multifocal lesions, adjacent CIS and recurrence within 2-3 months of resection

17
Q

What is BCG?

A

bacillus Calmette-Guerrin , a live attenuated strain of Mycobacterium bovis

18
Q

When and why is BCG used?

A

Adjuvant for high grade Ta, TIS or T1, to reduce risk of recurrence. (can pass for low grade Ta only)

19
Q

What is dose of induction BCG? Data?

A

120mg intravesicularly for 6 weeks

Herr eta al JCO 1995, showed 10 survival advantage of 75% versus 55%.

20
Q

Maintenance BCG? Data

A

weekly for 3 weeks every 6 months over 2-3 years superior to induction alone.
Malmstrom et al Eur Urology 2009

21
Q

What is most common side effect in patients receiving BCG? When is one concerned for systemic infection?

A
  • self-limited localized BCG cyctitis with increased urinary frequency, low grade fever and hematuria
  • if symptoms persist beyond 48 hours
22
Q

When is cystectomy recommended for non-invasive disease?

A

Failure to control CIS or recurrence of T1 tumor at 6-12 months despite standard therapy.

23
Q

What T stages of muscle invasive disease is resectable?

A

T2:muscle invasion
T3:perivesicular fat invasion
T4a:pelvic organ invasion only (prostate, uterus, vagina)

24
Q

What is recommended for those seeking bladder preservation despite muscle invasive disease? Most prolific author on this subject?

A

Agressive TUR followed by concurrent chemoradiation with cisplatin.
-Shipley

25
Q

What is standard recommendation for muscle-invasive bladder cancer that is resectable?

A

neoadjuvant chemotherapy

  • CMV (cisplatin, mtx and vinblastine)
  • MVAC (+doxorubicin, phase III SWOG, 3 cycles, median OS 77% vs 46%)
26
Q

What is median survival of metastatic bladder cancer with aggressive chemotherapy?

A

14 months

27
Q

What is standard firstline therapy in metastatic bladder cancer?

A

MVAC

  • mtx 30 mg/m2 day 1, 15, 22
  • vinblastine 3mg/m2 day 2, 15, 22
  • doxorubicin 30mg/m2 & cisplatin 70mg/m2 on day 2
28
Q

What alternate regimen can be used first line for metastatic bladder cancer, if favorable saftey profile is desired? Data?

A

GC
-Gemcitabine 1000mg/m2 days 1, 8, 15
-Cisplatin 70mg/m2 day 2
Von der Maase JCO 2000 (similar RR (47% vs 46%), TTP (7.4 months) and MS (13.8 vs 14.8 months)

29
Q

Does the addition of paclitaxel help GC?

A

overall and complete responses improved, but median survival was not statistically different (15.7 vs 12.8 months, p=0.1)

30
Q

What is salavge therapy for metastatic bladder cancer?

A

No standard, single agents show 20% or less RR

Oncology (7 decks)

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