Brainscape's Knowledge GenomeTM

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


See full index

AUA Oncology Guidelines 2024 > NMIBC Guidelines > Flashcards

NMIBC Guidelines Flashcards

1
Q

What should a clinician do at the time of resection of suspected bladder cancer?

A

Perform a thorough cystoscopic examination of the entire urethra and bladder, documenting tumor size, location, configuration, number, and mucosal abnormalities.

Clinical Principle

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

What should a clinician do at the initial diagnosis of bladder cancer?

A

Perform complete visual resection of the bladder tumor(s) when technically feasible.

Clinical Principle

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

What imaging should be performed as part of the initial evaluation of bladder cancer?

A

Upper urinary tract imaging.

Clinical Principle

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

What should be considered for a patient with a history of NMIBC with normal cystoscopy and positive cytology?

A

Consider prostatic urethral biopsies, upper tract imaging, enhanced cystoscopic techniques, ureteroscopy, or random bladder biopsies.

Expert Opinion

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

How should a clinician classify a patient at each occurrence/recurrence of bladder cancer?

A

Assign a clinical stage and classify the patient as ‘low-‘, ‘intermediate-‘, or ‘high-risk.’

Moderate Recommendation; Grade C

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

When should a pathology review be done by an experienced genitourinary pathologist?

A

When there is any doubt regarding variant or suspected variant histology, such as micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid, or extensive squamous or glandular differentiation.

Moderate Recommendation; Grade C

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

What should be done if a bladder-sparing approach is being considered for a patient with variant histology?

A

Perform a restaging TURBT within 4-6 weeks of the initial TURBT.

Expert Opinion

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

What should be considered due to the high rate of upstaging associated with variant histology?

A

Consider offering initial radical cystectomy.

Expert Opinion

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

Should urinary biomarkers be used in place of cystoscopic evaluation for NMIBC surveillance?

A

No, urinary biomarkers should not be used as a replacement for cystoscopic evaluation.

Strong Recommendation; Grade B

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

Should a clinician use urinary biomarkers or cytology during surveillance for a patient with low-risk cancer and normal cystoscopy?

A

No, routine use is not recommended.

Expert Opinion

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

When may biomarkers be used in NMIBC patients?

A

To assess response to intravesical BCG and adjudicate equivocal cytology.

Expert Opinion

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

What should be done if the initial resection of non-muscle invasive disease was incomplete?

A

Perform repeat TURBT or endoscopic treatment of all remaining tumors if technically feasible.

Strong Recommendation; Grade B

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

What is recommended for high-risk, high-grade Ta tumors after initial TURBT?

A

Consider repeat TURBT within 6 weeks of the initial procedure.

Moderate Recommendation; Grade C

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

What should a clinician do for T1 disease following the initial TURBT?

A

Perform a repeat TURBT to include muscularis propria within 6 weeks.

Strong Recommendation; Grade B

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

When should a clinician consider administering a single postoperative instillation of intravesical chemotherapy?

A

For low- or intermediate-risk bladder cancer within 24 hours of TURBT, unless there is suspected perforation or extensive resection.

Moderate Recommendation; Grade B

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

Should induction intravesical therapy be given to low-risk patients?

A

No, it is not recommended.

Moderate Recommendation; Grade C

17
Q

What is recommended for intermediate-risk patients regarding intravesical therapy?

A

Consider a 6-week course of induction intravesical chemotherapy or immunotherapy.

Moderate Recommendation; Grade B

18
Q

What should be administered to high-risk patients with newly diagnosed CIS, high-grade T1, or high-risk Ta urothelial carcinoma?

A

A 6-week induction course of BCG.

Strong Recommendation; Grade B

19
Q

What is recommended for intermediate-risk patients who completely respond to induction intravesical chemotherapy?

A

Consider maintenance therapy.

Conditional Recommendation; Grade C

20
Q

What should a clinician consider for intermediate-risk patients who completely respond to induction BCG?

A

Maintenance BCG for one year, as tolerated.

Moderate Recommendation; Grade C

21
Q

How long should maintenance BCG be continued for high-risk patients who respond to induction BCG?

A

Up to three years, as tolerated, based on availability.

Moderate Recommendation; Grade B

22
Q

What should be considered for intermediate- or high-risk patients with persistent or recurrent disease after intravesical therapy?

A

Perform prostatic urethral biopsy and upper tract evaluation before administering additional intravesical therapy.

Conditional Recommendation; Grade C

23
Q

What should be offered to intermediate- or high-risk patients with persistent or recurrent Ta or CIS disease after a single induction course of BCG?

A

A second course of BCG.

Moderate Recommendation; Grade C

24
Q

What is recommended for patients with high-grade T1 disease after a single induction course of BCG if they are fit for surgery?

A

Offer radical cystectomy.

Moderate Recommendation; Grade C

25
Q

Should additional BCG be prescribed to a patient intolerant of BCG or with documented recurrence within six months of two induction courses of BCG?

A

No, it is not recommended.

Moderate Recommendation; Grade C

26
Q

What options are available for patients with persistent or recurrent high-grade NMIBC within 12 months of adequate BCG therapy and unfit for cystectomy?

A

Clinical trials, alternative intravesical therapies, or systemic immunotherapy with pembrolizumab.

Conditional Recommendation; Grade C

27
Q

Should radical cystectomy be performed for patients with low- or intermediate-risk Ta disease before other treatments fail?

A

No, bladder-sparing modalities should be tried first.

Clinical Principle

28
Q

When should initial radical cystectomy be considered for high-risk patients?

A

If there is persistent high-grade T1 disease on repeat resection, or T1 tumors with CIS, LVI, or variant histologies.

Moderate Recommendation; Grade C

29
Q

What should be offered to high-risk patients with persistent or recurrent disease within one year after two induction cycles of BCG?

A

Radical cystectomy.

Moderate Recommendation; Grade C

30
Q

What is recommended at the time of TURBT for NMIBC patients to increase detection and reduce recurrence?

A

Offer blue light cystoscopy (BLC), if available.

Moderate Recommendation; Grade B

31
Q

When should narrow-band imaging (NBI) be considered for NMIBC patients?

A

To increase detection and reduce recurrence.

Conditional Recommendation; Grade C

32
Q

When should the first surveillance cystoscopy be performed after initial evaluation and treatment of NMIBC?

A

Within 3-4 months.

Expert Opinion

33
Q

What is the recommended surveillance schedule for a low-risk patient after a negative first surveillance cystoscopy?

A

Six to nine months later, then annually; further follow-up is based on shared decision-making.

Moderate Recommendation; Grade C

34
Q

Should routine surveillance upper tract imaging be performed for asymptomatic patients with low-risk NMIBC?

A

No, it should not be performed routinely.

Expert Opinion

35
Q

What alternative treatment can be considered for patients with low-grade Ta disease and sub-centimeter papillary tumors?

A

In-office fulguration as an alternative to resection under anesthesia.

Expert Opinion

36
Q

What is the recommended follow-up surveillance schedule for intermediate-risk patients after the first negative cystoscopy?

A

Every 3-6 months for 2 years, then 6-12 months for years 3 and 4, and annually thereafter.

Expert Opinion

37
Q

What follow-up schedule is recommended for high-risk patients after the first negative cystoscopy?

A

Every 3-4 months for 2 years, then every 6 months for years 3 and 4, and annually thereafter.

Expert Opinion

38
Q

When should surveillance upper tract imaging be considered for intermediate- or high-risk patients?

A

At 1- to 2-year intervals.

Expert Opinion

AUA Oncology Guidelines 2024 (4 decks)

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