Non-Metastatic MIBC Flashcards
What should be included in the initial evaluation before considering treatment for suspected invasive bladder cancer?
A full history, physical exam, and exam under anesthesia during TURBT.
Clinical Principle
What does a complete staging evaluation for muscle-invasive bladder cancer include?
Imaging of the chest, cross-sectional imaging of the abdomen and pelvis with IV contrast, and a comprehensive metabolic panel.
Clinical Principle
Who should review the pathology if variant histology or equivocal muscle invasion is suspected?
An experienced genitourinary pathologist.
Clinical Principle
What should be discussed with patients with newly diagnosed muscle-invasive bladder cancer before determining a treatment plan?
Curative treatment options using a multidisciplinary approach.
Clinical Principle
What should clinicians counsel patients about prior to treatment?
Complications and impact on quality of life, including effects on continence, sexual function, fertility, bowel function, and metabolic problems.
Clinical Principle
What chemotherapy should be offered to eligible radical cystectomy patients prior to surgery?
Cisplatin-based neoadjuvant chemotherapy.
Strong Recommendation; Grade B
Should carboplatin-based NAC be prescribed for clinically resectable stage cT2-T4aN0 bladder cancer?
No, it should not be prescribed; patients ineligible for cisplatin-based NAC should proceed to definitive locoregional therapy or a clinical trial.
Expert Opinion
When should radical cystectomy be performed after NAC?
As soon as possible after completion and recovery from NAC, ideally within 12 weeks unless medically inadvisable.
Expert Opinion
What treatment should be offered to patients who have not received cisplatin-based NAC but have pT3-4 and/or N+ disease at cystectomy?
Adjuvant cisplatin-based chemotherapy or immunotherapy.
Moderate Recommendation; Grade C
What is recommended for surgically eligible patients with non-metastatic (M0) muscle-invasive bladder cancer?
Radical cystectomy with bilateral pelvic lymphadenectomy.
Strong Recommendation; Grade B
What should be removed during a standard radical cystectomy with curative intent in males and females?
In males, the bladder, prostate, and seminal vesicles; in females, the bladder and, if needed, adjacent reproductive organs based on disease characteristics.
Clinical Principle
When should sexual function-preserving procedures be considered?
For patients with organ-confined disease and absence of bladder neck, urethra, and prostate (male) involvement.
Moderate Recommendation; Grade C
What urinary diversions should be discussed with patients undergoing radical cystectomy?
Ileal conduit, continent cutaneous, and orthotopic neobladder.
Clinical Principle
What must be verified in patients receiving an orthotopic urinary diversion?
A negative urethral margin.
Clinical Principle
What should clinicians attempt in the perioperative setting?
Optimize patient performance status.
Expert Opinion
What prophylaxis is recommended for patients undergoing radical cystectomy?
Perioperative pharmacologic thromboembolic prophylaxis.
Strong Recommendation; Grade B
What therapy should be used to accelerate gastrointestinal recovery after radical cystectomy?
μ-opioid antagonist therapy, unless contraindicated.
Strong Recommendation; Grade B
What should patients receive before discharge after radical cystectomy?
Detailed teaching regarding care of their urinary diversion.
Clinical Principle
When should bilateral pelvic lymphadenectomy be performed?
At the time of any surgery with curative intent.
Strong Recommendation; Grade B
What nodes should be removed during standard lymphadenectomy?
External and internal iliac and obturator lymph nodes.
Clinical Principle
Who should be offered bladder-preserving therapy?
Patients with non-metastatic muscle-invasive bladder cancer who wish to retain their bladder or are unsuitable for radical cystectomy due to comorbidities.
Clinical Principle
What should be performed in patients considered for bladder-preserving therapy?
Maximal debulking TURBT and assessment of multifocal disease/CIS.
Strong Recommendation; Grade C
Should partial cystectomy or maximal TURBT be used as primary curative therapy for medically fit patients?
No, these should not be used if radical cystectomy is possible.
Moderate Recommendation; Grade C
Is radiation therapy alone recommended as a curative treatment?
No, it should not be offered alone for muscle-invasive bladder cancer.
Strong Recommendation; Grade C
What should be included in tri-modality bladder-preserving therapy?
Maximal TURBT, followed by chemotherapy with EBRT, and planned cystoscopic surveillance.
Strong Recommendation; Grade B
What is essential when using multimodal therapy with curative intent?
Radiation-sensitizing chemotherapy.
Strong Recommendation; Grade B
What should clinicians do after bladder-preserving therapy is completed?
Perform regular surveillance with CT scans, cystoscopy, and urine cytology.
Strong Recommendation; Grade C
What is recommended for patients with recurrent muscle-invasive disease after bladder-preserving therapy?
Radical cystectomy with bilateral pelvic lymphadenectomy.
Strong Recommendation; Grade C
What options are available for patients with non-muscle invasive recurrence?
Local measures (e.g., TURBT with intravesical therapy) or radical cystectomy.
Moderate Recommendation; Grade C
What imaging is recommended for patient follow-up?
Chest and cross-sectional imaging at 6-12 month intervals for 2-3 years, then annually.
Expert Opinion
How often should laboratory assessment be done following muscle-invasive bladder cancer therapy?
Every 3-6 months for 2-3 years, then annually.
Expert Opinion
What should be monitored after radical cystectomy in patients with a retained urethra?
The urethral remnant for recurrence.
Expert Opinion
What should clinicians discuss with patients regarding their bladder cancer diagnosis and treatment?
Coping mechanisms and support groups or counseling.
Expert Opinion
What healthy habits should bladder cancer patients be encouraged to adopt?
Smoking cessation, regular exercise, and a healthy diet.
Expert Opinion
How should patients with variant histology be managed?
Based on unique clinical characteristics, which may diverge from standard urothelial carcinoma management.
Expert Opinion
