Non-muscle invasive bladder cancer

Question 1

How big share of bladder cancer is non-muscle invasive?

Answer 1

~75%

Question 2

How common is recurrence of non-muscle invasive bladder cancer?

Answer 2

~70%

Question 3

What is the mortality of muscle-invasive bladder cancer?

Answer 3

50% dead in 5 years

Question 4

The layers of the bladder wall:

Answer 4

urothelium
lamina propria
muscularis propria
perivesical tissue

Question 5

What share of non-muscle invasive bladder cancer will progress?

Answer 5

~10-30%

Question 6

What share of bladder cancer is caused by occupations exposure (industrialized contries)?

Answer 6

~5-10%

Question 7

How high is the sensivity and specificity for cytology in bladder cancer?

Answer 7

Sensivity 12-48%

Specificity 87-95%

Question 8

Are there any urinary markers that you can use for screening of bladder cancer?

Answer 8

NOT YET when compared to cystoscopy

Question 9

How big share of CIS will progress to invasive bladder cancer?

Answer 9

> 30%

Question 10

What is the effect of single intravesical instillation of chemotherapy on solitary TaG1-2, <3cm no CIS?

Answer 10

Almost halves the recurrence rate

Question 11

What is the goal of TURB?

Answer 11

To perform a complete resection and make a correct diagnosis

Question 12

When is a biopsy of the prostatic urethra indicated?

Answer 12

Multifocality
CIS
Visible abnormalities in the prostate
On all re-TUR

Question 13

What are the befefits of photodynamic diagnosis in patients with non-muscle invasive bladder cancer?

Answer 13

improves the detection of CIS
lower cancer-specific motality
can help avoid perioperative single dose chemotherapy

Question 14

What is the challenge with identifying variant histology of urothelial carcinoma?

Answer 14

It can be mistaken for reactive processes or benign tumours

Question 15

Give four examples of variant histology of urothelial carcinoma:

Answer 15

Micropapillary variant
Sarcomatoid carcinoma
Plasmacytoid variant
Small cell carcinoma

Question 16

What characterizes Micropapillary variant of urothelial carcinoma?

Answer 16

Aggressive behaviour with high metastatic rate

95% are muscle-invasive at time of presentation

Question 17

What characterizes Sarcomatoid carcinoma of urothelial carcinoma?

Answer 17

No difference in survival when compared stage-for-stage with UrCa
BUT
70% of patients die within 2 years because of high stage

Question 18

What characterizes Plasmocytoid variant of urothelial carcinoma?

Answer 18

Locally infiltative & highly aggressive
Unique pattern of spread along the ureter
Chemo-sensitive but very poor prognosis

Question 19

What characterizes Small cell carcinoma of urothelial carcinoma?

Answer 19

Identical to undiffirentiated small-cell cancer of the lung
Associated with paraneoplatsic syndromes
High stage at presentation
50% disseminated disease with metastases to the brain and bone
5-year survival 16-29% (?) very poor prognosis

Question 20

How to accomplish smoking cessation?

Answer 20

A 2-3 min consultation on smoking increases the probability of smoking cessation by 60% (from 3-5%)
Nicotine substitutes
Motivational interviewing

Medicins: Bupropion and Vareniklin

Question 21

What is the effect of adjuvant intravesical chemotherapy instillations for intermediate risk tumours?

Answer 21

Reduce recurrence- but NOT progression- rates

Question 22

What is the proper management of pT1 after first TurB?

Answer 22

second resection TurB

and BCG for 1-3 years

Question 23

BCG contraindications:

Answer 23

Within 2 weeks fo TURB
Visible haematuria
After traumatic catheterisation
Symptomatic urinary tract infection