bladder cancer

Question 1

bladder cancer

Answer 1

most common urinary tract cancer
transitional cell carcinoma

risks include
smoking - most important
age

presents with painless haematuria

Question 2

bladder cancer treatment

Answer 2

Transurethral resection — The initial treatment of non-muscle invasive bladder tumors is a complete TURBT

Intravesical therapy — Induction (weekly for six weeks) intravesical therapy is indicated in patients with intermediate- and high-risk disease. This facilitates delivery of high local concentrations of a therapeutic agent within the bladder, potentially destroying viable tumor cells that remain following TURBT and preventing tumor implantation.

Surveillance — Careful follow-up is required for all patients with non-muscle invasive bladder cancer. Second primary tumors can develop in the urothelium anywhere along the genitourinary tract, including the renal pelvis, ureters, and urethra, as well as the bladder. Subsequent surveillance should include a careful program of cystoscopy and urine cytology beginning three months after the initial treatment.

Question 3

Advanced bladder cancer treatment

Answer 3

Any of the following represents a strong indication to proceed to cystectomy:
•T1 tumors with lymphovascular invasion
•Variant histologies, including micropapillary transitional cell carcinoma, sarcoma, squamous cell carcinoma, or adenocarcinomas
•T1, grade 3 tumors that were incompletely resected
•Prostatic duct/acinar CIS
•Women with bladder neck and/or urethra CIS

Neoadjuvant chemotherapy – Randomized clinical trials have demonstrated a clinically relevant and statistically significant survival advantage for patients with muscle invasive urothelial bladder cancer who receive platinum-based neoadjuvant chemotherapy prior to undergoing cystectomy.
Chemotherapy — Platinum-based chemotherapy is the preferred initial approach for systemic therapy in patients with metastatic disease.

Immunotherapy — The development of checkpoint inhibitors targeting the programmed cell death-1 protein (PD-1) or its ligand (PD-L1) has led to the evaluation of these agents in the treatment of metastatic or advanced urothelial carcinoma. These agents are now the preferred therapy for patients who have progressed during or after platinum-based chemotherapy. Approved checkpoint inhibitor immunotherapy agents include pembrolizumab, nivolumab, atezolizumab, avelumab, and durvalumab