Non-Metastatic MIBC Flashcards

1
Q

What should be included in the initial evaluation before considering treatment for suspected invasive bladder cancer?

A

A full history, physical exam, and exam under anesthesia during TURBT.

Clinical Principle

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2
Q

What does a complete staging evaluation for muscle-invasive bladder cancer include?

A

Imaging of the chest, cross-sectional imaging of the abdomen and pelvis with IV contrast, and a comprehensive metabolic panel.

Clinical Principle

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3
Q

Who should review the pathology if variant histology or equivocal muscle invasion is suspected?

A

An experienced genitourinary pathologist.

Clinical Principle

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4
Q

What should be discussed with patients with newly diagnosed muscle-invasive bladder cancer before determining a treatment plan?

A

Curative treatment options using a multidisciplinary approach.

Clinical Principle

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5
Q

What should clinicians counsel patients about prior to treatment?

A

Complications and impact on quality of life, including effects on continence, sexual function, fertility, bowel function, and metabolic problems.

Clinical Principle

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6
Q

What chemotherapy should be offered to eligible radical cystectomy patients prior to surgery?

A

Cisplatin-based neoadjuvant chemotherapy.

Strong Recommendation; Grade B

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7
Q

Should carboplatin-based NAC be prescribed for clinically resectable stage cT2-T4aN0 bladder cancer?

A

No, it should not be prescribed; patients ineligible for cisplatin-based NAC should proceed to definitive locoregional therapy or a clinical trial.

Expert Opinion

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8
Q

When should radical cystectomy be performed after NAC?

A

As soon as possible after completion and recovery from NAC, ideally within 12 weeks unless medically inadvisable.

Expert Opinion

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9
Q

What treatment should be offered to patients who have not received cisplatin-based NAC but have pT3-4 and/or N+ disease at cystectomy?

A

Adjuvant cisplatin-based chemotherapy or immunotherapy.

Moderate Recommendation; Grade C

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10
Q

What is recommended for surgically eligible patients with non-metastatic (M0) muscle-invasive bladder cancer?

A

Radical cystectomy with bilateral pelvic lymphadenectomy.

Strong Recommendation; Grade B

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11
Q

What should be removed during a standard radical cystectomy with curative intent in males and females?

A

In males, the bladder, prostate, and seminal vesicles; in females, the bladder and, if needed, adjacent reproductive organs based on disease characteristics.

Clinical Principle

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12
Q

When should sexual function-preserving procedures be considered?

A

For patients with organ-confined disease and absence of bladder neck, urethra, and prostate (male) involvement.

Moderate Recommendation; Grade C

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13
Q

What urinary diversions should be discussed with patients undergoing radical cystectomy?

A

Ileal conduit, continent cutaneous, and orthotopic neobladder.

Clinical Principle

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14
Q

What must be verified in patients receiving an orthotopic urinary diversion?

A

A negative urethral margin.

Clinical Principle

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15
Q

What should clinicians attempt in the perioperative setting?

A

Optimize patient performance status.

Expert Opinion

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16
Q

What prophylaxis is recommended for patients undergoing radical cystectomy?

A

Perioperative pharmacologic thromboembolic prophylaxis.

Strong Recommendation; Grade B

17
Q

What therapy should be used to accelerate gastrointestinal recovery after radical cystectomy?

A

μ-opioid antagonist therapy, unless contraindicated.

Strong Recommendation; Grade B

18
Q

What should patients receive before discharge after radical cystectomy?

A

Detailed teaching regarding care of their urinary diversion.

Clinical Principle

19
Q

When should bilateral pelvic lymphadenectomy be performed?

A

At the time of any surgery with curative intent.

Strong Recommendation; Grade B

20
Q

What nodes should be removed during standard lymphadenectomy?

A

External and internal iliac and obturator lymph nodes.

Clinical Principle

21
Q

Who should be offered bladder-preserving therapy?

A

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

22
Q

What should be performed in patients considered for bladder-preserving therapy?

A

Maximal debulking TURBT and assessment of multifocal disease/CIS.

Strong Recommendation; Grade C

23
Q

Should partial cystectomy or maximal TURBT be used as primary curative therapy for medically fit patients?

A

No, these should not be used if radical cystectomy is possible.

Moderate Recommendation; Grade C

24
Q

Is radiation therapy alone recommended as a curative treatment?

A

No, it should not be offered alone for muscle-invasive bladder cancer.

Strong Recommendation; Grade C

25
Q

What should be included in tri-modality bladder-preserving therapy?

A

Maximal TURBT, followed by chemotherapy with EBRT, and planned cystoscopic surveillance.

Strong Recommendation; Grade B

26
Q

What is essential when using multimodal therapy with curative intent?

A

Radiation-sensitizing chemotherapy.

Strong Recommendation; Grade B

27
Q

What should clinicians do after bladder-preserving therapy is completed?

A

Perform regular surveillance with CT scans, cystoscopy, and urine cytology.

Strong Recommendation; Grade C

28
Q

What is recommended for patients with recurrent muscle-invasive disease after bladder-preserving therapy?

A

Radical cystectomy with bilateral pelvic lymphadenectomy.

Strong Recommendation; Grade C

29
Q

What options are available for patients with non-muscle invasive recurrence?

A

Local measures (e.g., TURBT with intravesical therapy) or radical cystectomy.

Moderate Recommendation; Grade C

30
Q

What imaging is recommended for patient follow-up?

A

Chest and cross-sectional imaging at 6-12 month intervals for 2-3 years, then annually.

Expert Opinion

31
Q

How often should laboratory assessment be done following muscle-invasive bladder cancer therapy?

A

Every 3-6 months for 2-3 years, then annually.

Expert Opinion

32
Q

What should be monitored after radical cystectomy in patients with a retained urethra?

A

The urethral remnant for recurrence.

Expert Opinion

33
Q

What should clinicians discuss with patients regarding their bladder cancer diagnosis and treatment?

A

Coping mechanisms and support groups or counseling.

Expert Opinion

34
Q

What healthy habits should bladder cancer patients be encouraged to adopt?

A

Smoking cessation, regular exercise, and a healthy diet.

Expert Opinion

35
Q

How should patients with variant histology be managed?

A

Based on unique clinical characteristics, which may diverge from standard urothelial carcinoma management.

Expert Opinion