Bladder cancer Flashcards
What are is the pathological tpyes?
Urothelial carcinoma 90%
Non-urothelail - squamous (more common in high prevalence schistosomiasis areas) and adenocarcinoma
What are the T stages?
pTis - in situ pTa in urothelium pT1 into chorion pT2 into superficial muscle pT3a into deep muscle pT3b into perivesical fat pT4 into other organs
What is the difference in surgical management of muscle invasive vs non-invasive?
Invasive requires radial cystectomy surgical management
Non-invasive can be managed via cystoscopy
What are options for muscle invasive tumours?
Radical cystectomy if medically fit
Concurrent chemoradiotherapy otherwise
Is there a role for neoadjuvant chemotherapy?
Improves survival
What neoadjuvant chemotherapy regimen is used?
Cisplatin/gemcitabine
What is hte management of met bladder ca?
Cisplatin based, combination regimens
What are the contraindications for cisplatin?
CrCl <60ml/min
ECOG <2
Pre-existing hearing impairment or neuropathy
NYHA Class III heart failure
In general, which cancer response best to immune therapy?
Ones with high mutational burden
Which immunotherapies are used?
PD-1 nivolumab, pembrolizumab
PD-L1 - atezolizumab, durvalumab, Avelumab
What is the response rate to immunotheray?
0-29%
