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Cancer > Bladder > Flashcards

Bladder Flashcards

1
Q

What are some familial syndromes and genes associated with bladder cancer?

A
  • Lynch
  • Peutz-Jeghers
  • Li-Fraumeni
  • Neurofibromatosis
  • Cowden

GENES

  • N-acetyltransferases (NAT1 and NAT2 genes)
  • glutathione S-transferases
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2
Q

What are some malignant markers of bladder cancer?

A
  • most common is loss of chromosome 9 (esp. 9q)
  • p16 - > 50% of all bladder CA, squamous.
  • p53 - high grade, assoc. with CIS
  • RB - aggressive, assoc. with CIS
  • PTEN - assoc. with CIS
  • p27 - aggressive
  • RAS
  • Ki-67 - aggressive
  • FGFR3 - low grade, low malignant potential Ta
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3
Q

How would you stage a urothelial cancer that is a direct invasion through the bladder and into the prostatic stroma

A

T4

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4
Q

How would you stage a tumor that it’s in the prostatic urethra

A

T2 urethral

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5
Q

What is BCG Refractory

A

Persistent disease in 6 months or progression at 3 months

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6
Q

What is BCG Relapse

A

Recurrence after treatment (12 months or later)

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7
Q

What are the indications for 2nd look re-resection?

A
  1. Incomplete tumor resection
  2. high grade Ta or T1
  3. Large (>3cm) or multifocal tumor
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8
Q

What’s the percent of upstaging on re-resection

A

15% for Ta

30% for T1

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9
Q

What is the percent of persistent disease on re-resection?

A

48%

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10
Q

What are the rates of recurrence and progression for T1 and CIS?

A

RECURRENCE: 80% for both
PROGRESSION: 50% for T1, 40-80% for CIS

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11
Q

What is considered low risk bladder cancer?

A

PUNLUMP,

Low grade Ta < 3cm

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12
Q

What is considered intermediate risk bladder cancer?

A 
Low grade Ta > 3cm
Multifocal low grade Ta
Recurrent low grade Ta in < 1 year
High grade Ta < 3cm
Low grade T1
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13
Q

What is considered high risk bladder cancer?

A 
High grade Ta > 3cm
Multifocal high grade Ta
Recurrent high grade Ta
High grade T1
CIS
Multivariant
LVI 
high grade prostatic involvement
any BCG failure
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14
Q

what is the purpose of peri-operative intravesical chemotherapy?

A

Reduce the recurrence rate by 35%

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15
Q

Who should get peri-operative intravesical chemotherapy?

A

Low or intermediate risk

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16
Q

What is the recommended regimen for maintenance BCG?

A

3 week cycles at month 3, 6, 12, 18, 24, 30, 36

17
Q

what is the purpose of peri-operative intravesical chemotherapy?

A

To prevent recurrence and progression of disease

18
Q

What is BCG unresponsive?

A
  1. BCG refractory (persistent)

2. BCG relapse within 6 months (recur)

19
Q

What is the surveillance schedule for low risk bladder cancer?

A

No cytology
No imaging
Cysto: 3, 12, then annual

20
Q

What is the surveillance schedule for intermediate risk bladder cancer?

A

Imaging Q1-2y
Cytology
Cysto: 3, then 3-6mo x 2y, then 6-12mo x 2y, then annual

21
Q

What is the surveillance schedule for high risk bladder cancer?

A

Imaging Q1-2y
Cytology
Cysto: Q3mo x 2 yr, Q6mo x 2 year, then annual

22
Q

What is the purpose of enhanced cystoscopy

A
  1. Increase detection

2. Reduce recurrence

23
Q

What are the indications for immediate cystectomy?

A
  1. Variant histology
  2. LVI
  3. Persistent T1 on re-resection (no BCG)
  4. BCG failure
24
Q

How do you treat BCG sepsis?

A

isoniazid, rifampin, ethambutol +/- steroids

25
Q

what is the most clinical or pathologic parameter associated with progression of NMIBC?

A

tumor stage

also, grade and presence of CIS

26
Q

how do you manage a positive urethral margin

A

CONSIDER delayed total urethrectomy

27
Q

What is the regimen for neoadjuvant chemotherapy and who gets it?

A
  1. MVAC or Gem/Cis

2. muscle invasive bladder CA

28
Q

Who gets adjuvant chemotherapy?

A

Extravesical disease (T3 or T4) or positive lymphadenopathy at time of cystectomy

29
Q

What are the contraindications to an orthotropic neobladder?

A
  1. Positive urethral margin
  2. Chronic renal insufficiency
  3. Liver failure
  4. neurologic disease affecting dexterity
  5. Urethral stricture disease
  6. gross positive margins
  7. involvement of pubic bone
  8. chronic inflammatory bowel disease
  9. malignant bowel disease
30
Q

What is the best treatment for those undergoing bladder preservation therapy with residual disease after 2 cycles of chemo?

A

Cystoprostatectomy

31
Q

What is first line for metastatic bladder CA?

A

Gem/Cis or MVAC

If Cisplatin ineligible:

  1. Gem/Carbo,
  2. If express PDL 1: Atezolizumab or Pembrolizumab
  3. If platinum ineligible: Atezolizumab or Pembrolizumab
32
Q

What is 2nd line for metastatic bladder CA after progression on cisplatin?

A

Pembrolizumab (preferred)

Erdafitinib
Immune checkpoint inhibitor

33
Q

What can you give for metastatic bladder and failed cisplatin and immune checkpoint inhibitor?

A

Enfortumab

Ertafitinib

Cancer (6 decks)

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