Clinical Presentation of Bladder Cancer

Question 1

What are the FIVE initial evaluation examinations you will do when there is suspicion of bladder cancer?

Answer 1

1. History and PE
2. Office Cystoscopy
3. Consider cytology
4. Pelvoabdominal imaging
5. Screen for smoking

Question 2

What are the TWO primary evaluation steps with patients suspected of having bladder cancer?

Answer 2

1. Examination under anesthesia

2. TURBT

Question 3

After TURBT, will you give intravesical chemotherapy? If yes, within how many hours?

Answer 3

Yes

Within 24 hours, ideally within 6 hours

Question 4

What are the TWO medications used for intravesical chemotherapy?

Which one is preferred?

Why is it preferred?

Answer 4

Gemcitabine
Mitomycin

Preferred: Gemcitabine
Reason: Better cost and toxicity profile

Question 5

What are the THREE CONDITIONS that will make you consider selected mapping biopsies in the primary evaluation of bladder cancer?

Answer 5

Sessile tumor
Suspicious for high grade tumor
Suspicious fo Tis

Question 6

What are the two major categorizations of the presumptive clinical stages of bladder cancer?

Answer 6

Non Muscle Invasive Bladder Cancer (NMIBC)

Muscle Invasive Bladder Cancer (MIBC)

Question 7

For muscle invasive cancers, what are the FOUR additional staging workup that you will request?

Answer 7

CBC
Blood chem to include ALP
Chest imaging
Bone imaging as needed