Bladder Tumors 135-142 12th ed Flashcards
Is healthy diet and risk of urothelial cancer related?
There is a clear association between a healthy diet and a decreased
risk of urothelial cancer.
What are associated with development of bladder cancer?
There is no convincing evidence that alteration in fluid intake,
alcohol consumption, ingestion of artificial sweeteners, or analgesic
abuse increase the risk of bladder cancer; however, chronic
irritation, bacterial infection, and radiation have all been associated
with the development of bladder cancer.
What is the prognosis of prostatic urethral involvement based on layers involved?
Prostatic urethral involvement by transitional cell carcinoma without
invasion carries a relatively good prognosis; when it invades the
prostatic stroma, the prognosis is less good, and when it directly
invades the substance of the prostate from the bladder, the prognosis
is poor.
What genetic factors are associated with poor prognosis? Which one has a better prognosis?
In muscularis propria invasive urothelial cancer, alterations in TP53,
RB, and PTEN are poor prognostic indicators.
Genetic alterations in low-grade non-muscularis propria invasive
disease include alterations in FGFR-3 and deletions in chromosome
9.
Most important risk factor for progression of NMIBC
Grade
In low-risk disease are you required to do random biopsies?
All suspicious lesions should be sampled, but random biopsies are
not required in low-risk patients.
Is immediate intravesical therapy beneficial for high grade disease?
No
Contraindications to BCG intravesical therapy
BCG is contraindicated in the setting of a disrupted urothelium
because of the risk of intravasation and BCG sepsis.
If patient fails 2 courses of intravesical BCG, what are his options?
Following failure of a second course of intravesical therapy, patients
can be enrolled in clinical trials of new agents, consider combination
intravesical therapy, or proceed to cystectomy.
Hallmark of surveillance
Cystoscopy is the hallmark of surveillance. The surveillance
schedule should be individualized on the basis of risk stratification of
the most recently resected tumor.
What are the risk factors for metastases?
Lymphatic and vascular invasion are risk factors for metastases. The incidence of pelvic node metastases is directly related to the
depth of invasion and the presence of lymphovascular invasion.
What is the prognosis of muscularis propria invasive bladder cancer?
As many as 50% of patients with muscularis propria–invasive
bladder cancer succumb to their disease.
Who are the appropriate candidates for bladder preservation?
Appropriate candidates for bladder preservation (transurethral tumor
resection, chemotherapy, and radiation therapy thereby preserving
the bladder) are those who have
1. a solitary T2 lesion of small
diameter
2. no associated hydronephrosis
3. a visibly complete
resection
4. Such patients should have normal renal function.
How are neuroendocrine bladder tumors treated?
Treatment of neuroendocrine bladder tumors includes neoadjuvant
chemotherapy and surgical resection; neuroendocrine tumors may be
associated with a paraneoplastic syndrome (hypercortisolism and
hypercalcemia).
Where should biopsy of the prostatic urethra be done?
The highest concentration of prostatic ducts are located from the
mid-prostate to the veru at the 5 and 7 o’clock positions and are the
locations where CIS of the prostatic urethra is most likely to be
found (biopsy should be performed in this location).
Who are not good candidates for cisplatin chemotherapy?
Patients who are not good candidates for cisplatin chemotherapy are
those with
1. a poor performance status, 2. creatinine clearance less than
60 mL/min
3. hearing loss, peripheral neuropathy
4. heart failure.
What is the best practice regarding TURBT resection of bladder tumor and inclusion of muscle.
Initial transurethral resection of a bladder tumor should routinely be
performed to include muscle. There should be a 2-cm visibly
negative margin on the surface.
Which patients are amenable to partial cystectomy?
Patients amenable to partial cystectomy should have a solitary lesion
without associated CIS in which a 2-cm margin may be obtained,
which is far enough away from the ureteral orifices and bladder
neck that closure can be accomplished without compromising these
structures.
What are the boundaries of standard lymph node dissection in radical cystectomy?
The boundaries of a standard lymph node dissection are the
genitofemoral nerve laterally, internal iliac artery medially, Cooper
ligament caudally, and crossing of the ureter at the common iliac
artery cranially.
Is mechanical and antibiotic prep necessary in cystectomywith urinary diversion?
In preparation for a cystectomy and urinary diversion, mechanical
and antibiotic bowel prep is controversial. The data to justify
omitting this preparation come, for the most part, from the general
surgical literature in which the bowel is not opened in the peritoneal
cavity as it is in urology, particularly in continent diversions.
Administration of intravenous antibiotic prophylaxis 30–60 minutes
before the incision is recommended.
What type of ureteral intestinal anastomosis has the lowest stricture rate?
Antirefluxing anastomoses
have a 10%–20% stricture rate; refluxing anastomoses have a 3%–
10% stricture rate. The Wallace ureteral intestinal anastomosis has
the lowest stricture rate.
What conduit can lead hematuria-dysuria syndrome?
Complications specific to the use of stomach include the hematuriadysuria
syndrome and uncontrollable metabolic alkalosis in some
patients
What factors need to be met for a patient to be considered for retentive diversion?
If the patient is able to achieve a urine pH of 5.8 or less, can establish
a urine osmolality of 600 mOsm/kg or greater in response to water
deprivation, has a GFR that exceeds 60 mL/min, and has minimal
protein in the urine, he or she may be considered for a retentive
diversion.
