Bladder Malignanccy Flashcards
which is involved in ca bladder Aristocholic acid N acetyl transferase Glutathiones transferase All of the above
All
Lynch syndrome life time risk of utuc
6%
Screen for lynch syndrome in utic if
Based on this association, it has been suggested
that patients with UTUC should be evaluated for
Lynch syndrome if they
(1) are younger than 60 years of age;
(2) have a family history of UTUC, colon cancer
diagnosed before age 60 years, or endometrial
carcinoma; or
(3) have a personal history of colon or
endometrial cancer
Decreased risk in women in ubca
Parity late menarche and ocp use
Painless gross hematuria at dx
85%
Noninvasice gold std
Cytology
Mc tcc
Bladder > renal pelvis. Ureter urethra
Urachus bladder dome which type
Adenoca than tcc
Premalignant lesions
The 2004 World Health Organization classification
system for urothelial neoplasia classifies pre-
malignant lesions as urothelial hyperplasia (flat
and papillary), reactive atypia, urothelial atypia
of unknown significance (AUS), urothelial
dysplasia, and low-grade intraurothelial neoplasic
Metaplasia is benign.
Mc stage in bladder
T1
Urinary conduit jejunum compli
Ileuma nd colon compli
Jejunum hypochloremic hyperkalemic metab acidosis
Ileum and colon- hyperchloremicb metab acidosis
Intravesical therapy rash and granulomatous prostatitis are side effects of
Mitomycin c and bcg respectively
Induction and maintenance therapy of bcg for
Induction 6 wks
Maintenance for intermediate - 1 yr
High - 3 yr
Bladder sparing feasible when?
tumor presentations associated with successful
bladder-sparing therapy include:
solitary T2 or early T3 tumors(typically <6 cm in
size),
no tumor-associated hydronephrosis,
tumors allowing a visibly complete TURBT,
invasive tumors not associated with extensive
carcinoma in situ, and
urothelial carcinoma histology
Immediate inteavesica therapy can be giben in
Low frade low volume Ta disease
Within 24 hrs of turbt
Gemcitabine > mitomycin
High risk pathology
Lvi
Micropapillary and prostatic urethra invasion
Aggressive histology
Micropapillary
Sarcomatoid
Plasmacytoid
T2n0 in bladder
Nact rt fb cystectomy
cisplatin based if adeq egfr
Bladder preservation candidates
Less than 6cm t2/3 Max debulking done Mild hydronephrosis No extensive tis Not multifocal
Molecular genomictest done for
Stage IIIB
FGFR2 and 3
No role for ACT OR NACT IN
Adrno ca or scc bladder
Five subtypes of ubca by which study
Lund university
But we folow tgca now- luminal luminal papilalry etc
Nmibc clasify by
Uromol
FGFR3 highest in
Luminal papillary
Mc in females with p53
Basal squamous
Mc genomic alteration
TERT 60-80%
Mc mutation in Ta
Fgfr3
Mc mut in mibc
P53 mc
Rb
Cdkn2a
After nact t2 no adjuvant is
Nact- ddmvac
Adjuvant pt34 n+- ddmvac
Adjuvant ypt2 n+- nivolumab
Stage 4 mets sustemic therapy
Cisplatin eligible gemcitabine cispla fb avelumab Ddmvac fb avelu Ineligibke carbogemci fb avelu Atezoli Pembroli
Radiosensitising chemo for organ preserving crt
Cisplatin fu
Cispacli
Fu mito
