Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EAMC Urology > NCCN Bladder 6.2020 > Flashcards

NCCN Bladder 6.2020 Flashcards

1
Q

INITIAL EVALUATION

Suspicious bladder mass

A 
H and PE
Office cystoscopy
Consider cytology
Abdominal and pelvic imaging with upper tract collecting system BEFORE TURBT
Smoking screening

BL-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PRIMARY EVALUATION and SURGICAL TREATMENT

Bladder mass

A

EUA/bimanual exam
TURBT
Single-dose intravesical chemotherapy within 24 hours of TURBT: Gemcitabine (preferred, cat 1) or mitomycin (cat 1)
Sessile or suspicious for high grade or Tis: selected mapping biopsies
Upper tract imaging if not yet done

BL-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Initial workup for muscle-invasive bladder CA

A

CBC
Chemistry profile, with ALK PHOS
Chest imaging
Bone imaging, if suspicious/symptomatic

BL-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Thanos FAQ!

“Sige, immediate intravesical chemotherapy reduces the ________ by ________ %.”

A

Immediate intravesical chemotherapy reduces 5-year RECURRENCE (rekerens) rate by 35 %, and has a NNT to prevent recurrence of 7.

Does NOT reduce risk of progression or mortality.

BL-1 footnote, BL-F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SECONDARY SURGICAL TREATMENT/ADJUVANT INTRAVESICAL TREATMENT

cTa, low grade

A

Observation
OR
Intravesical therapy

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SECONDARY SURGICAL TREATMENT/ADJUVANT INTRAVESICAL TREATMENT

cTa, high grade

A

Repeat TURBT if:

  1. Incomplete resection
  2. No muscle in specimen
Then:
BCG (preferred)
OR
Intravesical chemotherapy
OR
Observation

If BCG given –> give maintenance BCG (preferred)

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SECONDARY SURGICAL TREATMENT

cT1

A

Strongly advise repeat TURBT
OR
Consider cystectomy if high-grade

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ADJUVANT INTRAVESICAL TREATMENT
cT1
Repeat TURBT: (+) residual disease

A

BCG (cat 1)
OR
Cystectomy

If BCG given –> give maintenance BCG (preferred)

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADJUVANT INTRAVESICAL TREATMENT
cT1
Repeat TURBT: (-) residual disease

A 
BCG (cat 1)
OR
Intravesical chemotherapy 
OR
Observation in highly selected cases: low grade, limited lamina propria invasion, no CIS

If BCG given –> give maintenance BCG (preferred)

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ADJUVANT INTRAVESICAL TREATMENT

Tis

A

BCG

BL-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Evaluation and Treatment
Posttreatment cTa, T1, Tis recurrent or persistent
Cystoscopy: positive

A

TURBT
Single-dose intravesical chemotherapy within 24 hours of TURBT: gemcitabine (cat 1) or mitomycin (preferred, cat 1)

Based on tumor grade and stage: 
Adjuvant intravesical therapy
OR
Cystectomy
OR
Pembrolizumab

BL-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pembrolizumab is indicated for ________.

A

Pembrolizumab is indicated for treatment of patients with:
BCG-unresponsive high-risk, NMIBC with Tis or without papillary tumors

BL-3, footnote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Valrubicin is approved for ________.

A

Valrubicin is approved for BCG-refractory carcinoma in situ.

BL-3, footnote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Evaluation and Treatment
Posttreatment cTa, T1, Tis recurrent or persistent
Cystoscopy: suspicious for recurrence post-intravesical therapy (no more than 2 cycles)

A

TURBT
Single-dose intravesical chemotherapy within 24 hours of TURBT: gemcitabine (cat 1) or mitomycin (preferred, cat 1)

TURBT result:

  • No residual disease: maintenance BCG (preferred)
  • cTa, cT1, Tis: cystectomy (preferred for cT1 OR pembrolizumab (select patients) or change intravesical agent (consider)
  • T2 or higher: RESTAGE and manage accordingly

BL-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Evaluation and Treatment

Cytology: positive
Imaging: negative
Cytoscopy: negative

A 
Selected mapping biopsies including transurethral prostate biopsy
AND
Upper tract cytology
AND
Consider URS
AND 
Enhanced cystoscopy (if available)

BL-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: bladder, prostate, upper tract negative

A

Follow-up at 3 mo, then at longer intervals
OR
If prior BCG, maintenance BCG (optional)

BL-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: bladder positive

A

BCG, then:
If no evidence of disease (NED): maintenance BCG (preferred)
If persistent r recurrent disease:
Cystectomy OR pembrolizumab (select pxs) OR change intravesical agent (if incomplete response, cystectomy OR pembrolizumab)

If BCG-unresponsive:
Cystectomy OR pembrolizumab (in select patients)

BL-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

WORKUP

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: prostate positive

A

Urothelial CA of the Prostate!

DRE 
Cystoscopy (with bladder biopsy)
TUR biopsy of prostate to include stroma
PSA
Needle biopsy if DRE is abnormal (in selecte patients)
Imaging of upper tract collecting system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PRIMARY TREATMENT

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: prostate positive: MUCOSAL prostatic urethra

A

TURP and BCG

If on ffup imaging: local recurrence, then cystoprostatectomy + urethrectomy

UCP-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PRIMARY TREATMENT

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: prostate positive: ductal + acini

A

CXR + abdominal/pelvic CT

Cystoprostatectomy + urethrectomy
OR
TURP and BCG, then if on ffup imaging: local recurrence, then cystoprostatectomy + urethrectomy

UCP-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PRIMARY TREATMENT

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: prostate positive: stromal invasion

A

CXR + abdominal/pelvic CT

Cystoprostatectomy + urethrectomy + neoadjuvant chemotherapy

then consider adjuvant chemotherapy (if neoadjuvant not given)

UCP-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PRIMARY TREATMENT

Cytology: positive
Imaging: negative
Cytoscopy: negative

After workup: prostate positive: metastatic

A

Systemic therapy

UCP-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PRIMARY TREATMENT and ADJUVANT TREATMENT

Stage II, cystectomy candidates

A

Neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy (cat 1)
OR
Neoadjuvant cisplatin-based combination chemotherapy followed by partial cystectomy (highly selected patients with solitary lesion in a suitable location, no Tis)
OR
Cystectomy alone for those not eligible to receive cisplatin-based chemotherapy
OR
Concurrent chemoradiotherapy (cat 1) then reassess after 2-3 mos –> no tumor: observe;
–> tumor: Tis Ta T1: intravesical BCG OR surgical consolidation OR treat as metastatic

BL-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PRIMARY TREATMENT and ADJUVANT TREATMENT

Stage II, NON-cystectomy candidates

A

Concurrent chemoradiotherapy (cat 1, preferred)
OR
RT
OR TURBT

Then reassess after 2-3 mos –> no tumor: observe;
–> tumor: Systemic therapy OR concurrent chemoRT or RT alone if no prior RT or TURBT and best supportive care

BL-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PRIMARY TREATMENT ADJUVANT TREATMENT

Stage IIIA, cystectomy candidates

A

Neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy (cat 1)
OR
Cystectomy alone for those not eligible to receive cisplatin-based chemotherapy
OR
Concurrent chemoradiotherapy (cat 1) then reassess after 2-3 mos –> no tumor: observe;
–> tumor: Tis Ta T1: intravesical BCG OR surgical consolidation OR treat as metastatic

BL-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PRIMARY TREATMENT and ADJUVANT TREATMENT

Stage IIIA, NON-cystectomy candidates

A

Concurrent chemoradiotherapy (cat 1) then reassess after 2-3 mos;
- no tumor: observe;
- tumor: systemic therapy OR TURBT OR best supportive care
OR
RT

BL-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Optimal candidates for bladder preservation with chemoRT:

A

Patients with tumors WITHOUT hydronephrosis
NO concurrent or extensive Tis
< 6 cm

Tumors should allow visually complete or maximally debulking TURBT

BL-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

ADJUVANT TREATMENT

Stage IIIA, cystectomy candidates

A

Based on pathologic risk (pT3-T4 or positive nodes or positive margins:
Consider adjuvant cisplatin-based chemotherapy or adjuvant RT (cat 2B) if no neoadjuvant given

BL-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PRIMARY TREATMENT

Stage IIIB, downstaging systemic therapy option

A

Downstaging systemic therapy, then reassess tumor status 2-3 mo after treatment

Complete response: Consolidation cystectomy OR consolidation chemoRT OR observation

Partial response: Cystectomy OR chemoRT OR treat as metastatic

Progression: treat as metastatic

BL-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PRIMARY TREATMENT

Stage IIIB, concurrent chemoradiotherapy

A

Reassess tumor status 2-3 mo after treatment

Complete response: ffup algorithm

Partial response: Tis, Ta, T1 consider intravesical BCG OR surgical consolidation OR treat as metastatic

Progression: treat as metastatic disease

BL-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PRIMARY TREATMENT

Stage IVA, M0

A

Systemic therapy –> 2-3 cycles, reassess with cystoscopy, EUA, TURBT, and imaging of abd/pelvis
OR
Concurrent chemoRT, then reassess after 2-3 months

  • No tumor: consolidation systemic therapy OR chemoradiotherapy (if no previous RT) and/or cystectomy
  • Tumor present: systemic therapy OR chemoRT (if no previous RT) and/or cystectomy

BL-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PRIMARY TREATMENT

Stage IVA, M1a disease

A

Systemic therapy, then evaluate with cystoscopy, EUA, TURBT, and imaging of abd/pelvis

If CR: Concurrent chemoRT OR cystectomy
Stable disease or progression: treat as metastatic

BL-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

WORKUP and PRIMARY TREATMENT

Metastatic Stage IVB

A 
Bone scan
Chest CT
Consider CNS imaging
GFR scan, to assess cisplatin eligibility
Consider biopsy if feasible
Molecular/genomic testing

Systemic therapy
AND/OR
Palliative RT

BL-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

TREATMENT
Local recurrence or persistent disasese;
Preserved bladder
Muscle-invasive

A 
Cystectomy
OR
ChemoRT (if no prior RT)
OR
Systemic therapy
OR
Palliative TURBT and best supportive care

BL-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

TREATMENT
Local recurrence or persistent disasese;
Preserved bladder
Tis, Ta, or T1

A 
Consider intravesical therapy --> if no response --> cystectomy
OR
Cystectomy
OR
TURBT

BL-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

TREATMENT
Cytology: positive
Preserved bladder
Cystoscopy, EUA, selected mapping biopsy: negative

A

Retrograde selective washings of the upper tract
Prostatic urethral biopsy

Upper tract positive –> UTUC
Prostate positive –> UCP

BL-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

TREATMENT

Metastatic or local recurrence postcystectomy

A 
Systemic therapy
OR
ChemoRT (if no previous RT)
OR
RT

BL-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

TURBT: muscle may be omitted in _________.

A

Documented low-grade Ta disease

BL-B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

TURBT: suspected or known CIS:

A

Biopsy adjacent to papillary tumor
Consider prostate urethral biopsy

BL-B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

TURBT: Papillary appearing tumor (likely NMIBC) - repeat TURBT after 6 weeks if:

A

Incomplete resection
No muscle in original specimen for high-grade
Large (>= 3 cm) or multi-focal lesions
Any T1 lesion

BL-B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

TURBT: Sessile/flat or invasive appearing tumor (likely MIBC), repeat TURBT if:

A

No muscle in original specimen for high-grade
Any T1 lesion
First resection does not allow adequate staging for treatment selection
Incomplete resection and considering tri-modality bladder preservation therapy

BL-B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Maximal TURBT + concurrent chemoRT is most suitable for patients with:

A 
Solitary tumors
Negative nodes
No CIS
No tumor-related hydronephrosis
Good pretreatment bladder function

BL-B

43
Q

Regional lymphadenectomy recommended for:

A

High-grade upper GU tract tumors

BL-B

44
Q

Regional lymphadenectomy for:

Left-sided renal pelvic, upper ureteral, and midureteral tumors

A

Paraaortic LNs from renal hilum to aortic bifurcation

Midureteral tumor: include common iliac, external iliac, obturator, hypogastric LNs

BL-B

45
Q

Regional lymphadenectomy for:

Right-sided renal pelvic, upper ureteral, and midureteral tumors

A

Paracaval LNs from renal hilum to IVC bifurcation

Midureteral tumor: include common iliac, external iliac, obturator, hypogastric LNs

BL-B

46
Q

Regional lymphadenectomy for:

Distal ureteral tumors

A

Common iliac
External iliac
Obturator
Hypogastric LNs

BL-B

47
Q

Pelvic Exenteration (cat 2B)

A

For recurrence in female patients with >= T2 primary carcinoma of the urethra
Ilioinguinal lymphadenectomy and/or chemoRT for >=T3

BL-B

48
Q

TURP is the primary treatment option for:

A

Urothelial carcinoma of the prostate with ductal/acini or prostatic urethral pathology.
Postsurgical intravesical BCG recommended.

BL-B

49
Q

TUR of urethral tumor is the primary treatment for:

A

Tis, Ta, and T1 primary carcinoma of the urethra.
Consider postsurgical intraurethral therapy

BL-B

50
Q

Partial cystectomy indications

A 
cT2 muscle-invasive disease with solitary lesion amenable to resection with adequate margins
Select situations (including cancer in bladder diverticulum)
No CIS as determined by random biopsies

Give: neoadjuvant cisplatin-based chemotherapy
Bilateral pelvic lymphadenectomy: common iliac, internal and external iliac, obturator nodes

BL-B

51
Q

Radical nephrouretectomy with bladder cuff is the primary treatment for:

A

Non-metastatic high-grade upper GU tract tumors (UTUC)

Consider single-dose immediate postop intravesical chemotherapy (decrease in intravesical recurrence)
Neoadjuvant chemotherapy: consider in high-grade disease

BL-B

52
Q

Favorable criteria for nephron preservation in UTUC

A

Low-grade tumor based on cytology and biopsy
Papillary architecture
Tumor size <1.5 cm
Unifocal tumor
Cross-sectional imaging showing no concern for invasive disease

BL-B

53
Q

Less favorable criteria for nephron preservation in UTUC

A 
Multifocal tumors
Flat or sessile tumor architecture
Tumor size > 1.5 cm
High-grade tumors
cT2-T4
Mid and proximal tumor due to technical challenges
Tumor crossing the infundibulum or UPJ

BL-B

54
Q

Imperative indications for conservative therapy of UTUC

A

Bilateral renal pelvis and/or urothelial carcinoma of the ureter
Solitary or solitary functioning kidney
Chronic kidney disease/renal insufficiency
Hereditary predisposition (HNPCC)

BL-B

55
Q

Mixed histology urothelial cancer should be treated in a similar manner to:

A

Pure urothelial carcinoma

BL-D

56
Q

Pure squamous cell carcinoma of the bladder

A

No proven role for neoadjuvant chemotherapy
Local control with surgery + RT recommended
Clinical trial for advanced disease
Paclitaxel + ifosfamide + cisplatin for selected patients
Postoperative RT for positive margins
Best supportive care

BL-D

57
Q

Pure adenocarcinoma including urachal, localized disease

A

No proven role for neoadjuvant chemotherapy
Local control with surgery + RT recommended

Urachal with localized disease:
Partial or complete cystectomy with en bloc resection of the urachal ligament with umbilicus and LN dissection

Best supportive care

BL-D

58
Q

Pure adenocarcinoma including urachal, node-positive and advanced disease

A

FOLFOX: oxaliplatin, leucovorin, and 5-FU
or
GemFLP: 5-FU, leucovorin, gemcitabine, and cisplatin

BL-D

59
Q

Treatment for any small-cell component

A

Concurrent chemoRT or neoadjuvant chemotherapy followed by local treatment (cystectomy or radiotherapy)

Neoadjuvant chemotherapy:
Etoposide + cisplatin
Ifosfamide + doxorubicin with etoposide + cisplatin

If cisplatin ineligible:
etoposide + carboplatin

BL-D

60
Q

AUA Risk Stratification for NMIBC:

Low Risk

A

Low grade solitary
Papillary urothelial neoplasm of LMP

BL-E

61
Q

AUA Risk Stratification for NMIBC:

Intermediate Risk

A 
Recurrence within 1 year, LG Ta
Solitary LG Ta > 3 cm
LG Ta, multifocal
High grade (HG) Ta, =< 3 cm 
LG T1

BL-E

62
Q

AUA Risk Stratification for NMIBC:

High Risk

A 
HG T1
Any recurrent, HG Ta
HG Ta, > 3 cm or multifocal
Any CIS
Any BCG failure in HG patient
Any variant histology
Any lymphovascular invasion
Any HG prostatic urethra involvement

BL-E

63
Q

FOLLOW-UP

Low-Risk, NMIBC

A

Cystoscopy: 3 and 12 mo, then annually
Upper tract and abdominal/pelvic imaging: baseline imaging, then annually as clinically indicated

BL-E

64
Q

FOLLOW-UP

Intermediate Risk, NMIBC

A

Cystoscopy: 3, 6, 12 mo, then every 6 mo for year 2, then annually for years 3-5
Upper tract and abdominal/pelvic imaging: baseline imaging in year 1, then as indicated
Urine cytology: 3, 6, 12 in year 1, urine cytology every 6 mo in year 2, then annually until year 5

BL-E

65
Q

FOLLOW-UP

High Risk, NMIBC

A

Cystoscopy: every 3 mo in years 1-2, every 6 mo in years 3-5, then annually
UT imaging: baseline imaging in year 1, then every 1-2 y
Abdominal/pelvic imaging: baseline at year 1, then as indicated

BL-E

66
Q

FOLLOW-UP

Postcystectomy NMIBC: cystoscopy schedule

A

Wala na siyang bladder! 😢

67
Q

FOLLOW-UP

Postcystectomy NMIBC

A

CTU or MRU at 3 and 12 mo in year 1, then annually until year 5, then US annually

Renal function tests, LFTs, CBC, CMP, B12 every 3-6 mo if received chemo in year 1, then annually

Urine cytology and urethral wash cytology every 6-12 mo until year 2, then as indicated

BL-E

68
Q

FOLLOW-UP

Postcystectomy muscle invasive BC

A

CTU or MRU, CXR or chest CT every 3-6 mo until year 2, then annually until year 5, then renal US annually
FDG PET/CT (cat 2b) if suspected metastatic disease

Renal function tests, LFTs, CBC, CMP, B12 every 3-6 mo if received chemo in year 1, then annually

Urine cytology and urethral wash cytology every 6-12 mo until year 2, then as indicated

BL-E

69
Q

FOLLOW-UP

Post-bladder sparing (partial cystectomy or chemoRT)

A

Cystoscopy: every 3 mo in years 1-2, then every 6 mo in years 3-4, then annually years 5-10
Imaging: CTU or MRU, CXR or chest CT every 3-6 mo in years 1-2
FDG PET/CT if mets suspected

Renal function tests, LFTs, CBC, CMP, B12 every 3-6 mo if received chemo in year 1, then annually

Urine cytology every 6-12 mo in years 1-2, then as indicated

BL-E

70
Q

Immediate postoperative intravesical chemotherapy timing:

A

Single instillation within 24 hours of surgery (ideally 6 hours)

BL-F

71
Q

Immediate intravesical agents

A

Gemcitabine (preferred due to better tolerability) (cat 1)
Mitomycin (cat 1)

NOT effective: thiotepa

BL-F

72
Q

Immediate postoperative intravesical chemotherapy NOT effective in:

A

Patients with elevated EORTC recurrence risk score >= 5, includes patients with >= 8 tumors and those with >= recurrence per year.

BL-F

73
Q

Immediate postoperative intravesical chemotherapy contraindications:

A

Bladder perforation
Known drug allergy

BL-F

74
Q

Induction (adjuvant) intravesical chemo or BCG is a treatment option for:

A

NMIBC

BL-F

75
Q

In the event of a BCG shortage, prioritize induction of:

A

High-risk patients (high-grade T1 and CIS)

BL-F

76
Q

In the event of a BCG shortage, multiple patients may be treated by:

A

splitting the dose of BCG (1/2 or 1/3)

BL-F

77
Q

Induction intravesical chemotherapy or BCG timing:

A

Start: 3-4 weeks after TURBT with or without maintenance

Weekly for 6 weeks, maximum of 2 consecutive cycle inductions without complete response

BL-F

78
Q

BCG contraindications:

A 
Traumatic catheterization
Bacteriuria
Persistent gross hematuria
Persistent severe local symptoms
Systemic symptoms

BL-F

79
Q

Maintenance intravesical BCG SWOG regimen

A

6-week induction course, then maintenace with 3 weekly instillations at months 3, 6, 12, 18, 24, 30, and 36.

BL-F

80
Q

What does “sessile” mean? 😅

A

Sessile means “flat”, as opposed to papillary which is pedunculated. Flat tumors are more likely to be CIS or invasive.

81
Q

Perioperative chemotherapy (neoadjuvant or adjuvant)

A

Preferred:
DDMVAC + growth factor suppport x 3-4 cycles
Gemcitabine and cisplatin x 4 cycles (21 days preferred)

Other:
CMV (cisplatin, methotrexate, and vinblastine) x 3 cycles

BL-G

82
Q

What does DDMVAC mean?

A

Dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin

BL-G

83
Q

First-line systemic therapy for locally advanced or metastatic disease (Stage IV)
Cisplatin eligible

A

Gemcitabine and cisplatin (cat 1) followed by avelumab maintenance therapy
DDMVAC with growth factor support (cat 1) followed by avelumab maintenance therapy

BL-G

84
Q

First-line systemic therapy for locally advanced or metastatic disease (Stage IV)
Cisplatin INeligible

A

Preferred:
Gemcitabine and carboplatin followed by avelumab maintenance therapy
Atezolizumab or Pembrolizumab ONLY for PD-L1 expressing tumors

BL-G

85
Q

Second-line systemic therapy for stage IV, post-PLATINUM

A

Preferred:
Pembrolizumab (cat 1)

Alternative preferred:
Atezolizumab
Nivolumab
Durvalumab
Avelumab
Erdafitinib

BL-G

86
Q

Second-line systemic therapy for stage IV, post-CHECKPOINT INHIBITOR

A

Preferred for cisplatin ineligible, chemo naive:
Gemcitabine/carboplatin

Cisplatin eligibile:
Gemcitabine/cisplatin
DDMVAC with GF support

BL-G

87
Q

Subsequent-line systemic therapy for stage IV

A

Preferred:
Enfortumab vedotin 🧐
Erdafitinib

BL-G

88
Q

Radiosensitizing chemotherapy regimens for organ-preserving chemoradiation

A 
Preferred:
Cisplatin and 5-FU
Cisplatin and paclitaxel 
5-FU and mitomycin
Cisplatin alone

BL-G

89
Q

Bladder

T1

A

Invades the lamina propria (subepithelial connective tissue)

ST-1

90
Q

Bladder
T2a
T2b

A

Invades the superficial (T2a) and deep (T2b) muscularis propria

ST-1

91
Q

T3a

T3b

A

Invades perivesical tissue microscopically (T3a) or macroscopically (T3b)

ST-1

92
Q

T4a

T4b

A

Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall

ST-1

93
Q

Bladder

N1

A

Single regional LN metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral LN)

ST-1

94
Q

Bladder

N2

A

Multiple regional LN metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral LN)

ST-1

95
Q

Bladder

N3

A

Lymph node metastasis to the common iliac LN

ST-1

96
Q

Bladder

M1a

A

Distant metastasis limited to LNs beyond the common iliacs

ST-1

97
Q

Bladder

M1b

A

Non-LN distant metastases

ST-1

98
Q

UTUC

T1

A

Subepithelial connective tissue

ST-1

99
Q

Adjuvant intravesical chemotherapy

Alternatives to BCG

A 
Mitomycin or gemcitabine
Epirubicin
Valrubicin
Docetaxel
Sequential gemcitabine/docetaxel or gemcitabine/mitomycin

Split dose BCG: 1/3 or 1/2 dose

BL-F

100
Q

Adjuvant intravesical chemotherapy

Timing

A

Start: 3-4 weeks after TURBT with or without maintenance x weekly dose for 6 weeks

Maximum 2 cycles w/o complete response

BL-F

101
Q

Adjuvant/maintenance intravesical chemotherapy

Contraindications to BCG

A 
Traumatic catheterization
Bacteriuria
Persistent gross hematuria
Persistent severe local symptoms
Systemic symptoms

BL-F

102
Q

Immediate postop intravesical chemotherapy
Dose and Timing
Details
Contraindications

A

Single dose of gemcitabine or mitomycin within 24 hours (ideally within 6 hours)

Reduces recurrence by 35%
NNT to prevent recurrence of 7
NOT effective in: EORTC >= 5, >=8 tumors, >=1 recurrence per year

Contraindications to gemcitabine/mitomycin: Drug allergy, bladder perforation

103
Q

Maintenance intravesical BCG

SWOG regimen

A

6-week induction course of BCG
then
Maintenance: 3 weekly instillations at months 3, 6, 12, 18, 24, 30, 36

Intermediate risk: given for 1 year
High-risk: given for 3 years

EAMC Urology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions