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AUA guidelines > Non-muscle invasive bladder cancer > Flashcards

Non-muscle invasive bladder cancer Flashcards

1
Q

What are the demographics of NMIBC?

A

Caucasian american men (3:1) older than 65 years of age

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2
Q

What are the risk factors for bladder cancer?

A 
Tobacco smoking
Aromatic amines
polycyclic hydrocarbons
Arsenic
Cyclophosphamide

Lynch syndrome

Schistosoma hematobium (sqaumous cell)
Aristocholic acid (upper tracts)
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3
Q

What are some common mutations of tumor suppressor genes found in NMIBC?

A 
GSTM-1
NAT-2
P16
CDKN2A
PTEN
RB1
TP53
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4
Q

What are some oncogene mutations seen in NMIBC?

A

FGFR3
PIK3CA
RAS

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5
Q

What is the rate of urinary tract malignancy in patient with asymptomatic microscopic hematuria?

A

2.6%

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6
Q

What are the common presenting symptoms of NMIBC?

A

Hematuria

irritative voiding symptoms

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7
Q

What is Ta bladder cancer?

A

Non invasive papillary carcinoma

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8
Q

What is Tis bladder cancer?

A

Carcinoma in situ

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9
Q

What is T1 bladder cancer?

A

Tumor invades the lamina propria

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10
Q

What is T2a bladder cancer?

A

Tumor invades the muscularis propria inner half

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11
Q

What is T2b bladder cancer?

A

Tumor invades deep muscularis propria (outer half)

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12
Q

What is T3a bladder cancer?

A

Tumor invades perivesical fat microscopically

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13
Q

What is T3b bladder cancer?

A

Tumor invades perivesical fat macroscopically

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14
Q

What is T4a bladder cancer?

A

Tumor invades adjacent organs

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15
Q

What is T4b bladder cancer?

A

Tumor invades pelvic side wall.

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16
Q

What is the 10 year survival prognosis for high grade NMIBC?

A

70-85%

17
Q

What are the recurrence and progression rates for Ta NMIBC?

A

Recurrence: 55%
Progression: 6%

18
Q

What are the recurrence and progression rates for T1 high grade NMIBC?

A

Recurrence: 45%
Progression: 17%

19
Q

What defines low risk NMIBC?

A

Low grade
Solitary lesion
Ta < 3cm
Papillary urothelial neoplasm of low malignant potential

20
Q

What defines intermediate risk NMIBC?

A 
Recurrent low grade Ta within 1 year
Solitary LG Ta > 3cm
Multifocal LG Ta
HG Ta < 3cm 
LG T1
21
Q

What defines high risk NMIBC?

A

HG T1
Recurrent HG Ta
HG Ta > 3cm or multifocal

CIS
BCG failure in HG patient
Any variant histology

LVI
HG prostatic urethral involvement

22
Q

How should NMIBC be diagnosed?

A

By thorough cystoscopy.

23
Q

What should be the initial treatment of NMIBC?

A

At initial diagnosis of a patient with bladder cancer, a clinician should perform complete visual resection of the bladder tumor(s), when technically feasible

24
Q

What should be included in addition to cystoscopy for evaluation of hematuria or a suspected bladder tumor?

A

Upper tract imaging.

25
Q

What should be done if a patient has a normal cystoscopy but positive cytology?

A 
Prostatic urethral biopsies
Upper tract imaging
Ureteroscopy
Blue light cystoscopy
Random bladder biopsies
26
Q

What should be done if NMIBC shows variant histology?

A

Repeat TURBT in 4-6 weeks.

27
Q

What is the rate of muscle invasion with variant histology?

A

86%

28
Q

What is the preferred tx option for NMIBC with variant histology?

A

Due to the high rate of upstaging associated with variant histology, a clinician should consider offering initial radical cystectomy

29
Q

What are the 5 FDA approved tumor markers?

A 
NMP22
BTA
Urovysion FISH
Immunocyt
Cxbladder
30
Q

What is the role of urinary biomarkers in NMIBC?

A

In surveillance of NMIBC, a clinician should not use urinary biomarkers in place of cystoscopic evaluation.

31
Q

What is the role of urinary biomarkers during surveillance for low risk NMIBC?

A

In a patient with a history of low-risk cancer and a normal cystoscopy, a clinician should not routinely use a urinary biomarker or cytology during surveillance.

32
Q

What is the indication for urinary biomarkers in NMIBC?

A

In a patient with NMIBC, a clinician may use biomarkers to assess response to intravesical BCG (UroVysion® FISH) and adjudicate equivocal cytology (UroVysion® FISH and ImmunoCyt™). (Expert Opinion)

33
Q

What should be done for a patient with NMIBC who underwent an incomplete initial resection?

A

Repeat TURBT if feasible.

34
Q

What is the next step for high risk, high grade, Ta tumors after resection?

A

Repeat TURBT in 6 weeks.

35
Q

What percentage of T1 tumors get upstaged?

A

30%

36
Q

What is the next step after resection of a T1 NMIBC?

A

Repeat TURBT in 6 weeks.

37
Q

What percentage of high grade Ta NMIBC get upstaged?

A

15%

38
Q

What percentage of high grade Ta NMIBC have residual tumor?

A

50%

AUA guidelines (7 decks)

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