Principles of Surgical Management (Bladder Cancer)

Question 1

In doing TURBT for staging, when can you omit getting muscle for your specimen?

Answer 1

“In known cases of non muscle invasive disease

known Ta”

Question 2

Biopsy adjacent to the papillary tumor and/or prostate urethral biopsy can be performed if you are suspecting what disease entity?

Answer 2

Tis

Question 3

What is the timing of “early” repeat TURBT?

Answer 3

Within 6 weeks

Question 4

FOUR conditions to do early repeat TURBT?

Answer 4

“LARGE 3CM OR MORE OR MULTI-FOCAL LESIONS
ANY T1 LESION
No muscle in the specimen for high grade disease
Incomplete initial resection

Question 5

In doing TURBT for sessile or invasive appearing tumor, what are the FOUR conditions that will prompt you to do repeat TURBT?

Answer 5

”
“1 Prior resection did not inlcude muscle in the setting of high grade disease
2 Any T1 lesion
3 First resection does not allow adequate staging/attribution of risk for treatment selection
4 Incomplete resection and considering tri-modality preservation therapy

Question 6

Give the conditions to perform bladder preservation with maximally complete and safe TURBT + concurrent chemorad. There are FIVE conditions.

Answer 6

Solitary tumors
Negative nodes
No extensive or multifocal CIS
No tumor related hydronephrosis
Good pre treatment bladder function"

Question 7

Is TURBT alone for non-cystectomy candidates, a sound treatment option?

Answer 7

Yes

Question 8

TURP is the primary treatment option for urothelial carcinoma of the prostate with what two pathologies?

Answer 8

“1 Urothelial carcinoma of the prostate ductal/acini

2 Prostatic urethral pathology”

Question 9

What post surgical intravesical treatment is recommended post TURP for suspected urothelial carcinoma of the prostate?

Answer 9

BCG

Question 10

TUR of the urethral tumor is the primary treatment modality of what stages of urethral ca?

Answer 10

Tis Ta T1

Question 11

For patients with a prior radical cystectomy and a cutaneous diversion, what procedure should be considered in urethral tumors?

Answer 11

TOTAL URETHRECTOMY

Question 12

Is post op intraurethral therapy recommended for patients who underwent TUR of the urehtral tumor?

Answer 12

May consider

Question 13

A patient has carcinoma in situ in random biopsies, is partial cystectomy still an option?

Answer 13

No

Question 14

Should neoadjuvant cisplatin based combination chemotherapy be given prior to partial cystectomy?

Answer 14

Yes

Question 15

Should bilateral pelvic lymphadenectomy be performed in partial cystectomy?

Answer 15

Yes

Question 16

If pelvic lymphadenectomy is to be performed, which 4 nodal groups are included in partial cystectomy?

Answer 16

ICE O

INTERNAL ILIAC
COMMON ILIAC
EXTERNAL ILIAC
OBTURATOR NODES

Question 17

[Radical Cystectomy/Cystoprostatectomy] In NMIBC, radical cystectomy is reserved for what stage?

Answer 17

RESIDUAL HIGH GRADE T1

Question 18

Conditions for partial cystectomy?

Answer 18

Conditions for partial cystectomy?

Question 19

[Radical Cystectomy/Cystoprostatectomy] If no therapy is given, cystectomy should be done within how many months?

Answer 19

3 months

Question 20

[Radical Cystectomy/Cystoprostatectomy] Radical cystectomy is the primary treatment option for what T stages?
Inguinal lymphadenectomy and or chemorad

Answer 20

T2
T3
T4a

Question 21

[Radical Cystectomy/Cystoprostatectomy] A T4b lesion responds to primary treatment, can this be a candidate for cystectomy?

Answer 21

Yes, but should have responded to the primary treatment

Question 22

For what T stages should neoadjuvant cisplatin based combination chemotherapy be given when radical cystectomy is planned?

Answer 22

cT2 to T4a

Question 23

[Radical Cystectomy/Cystoprostatectomy] Should bilateral pelvic lymphadenectomy be performed?

Answer 23

Yes

Question 24

[Radical Cystectomy/Cystoprostatectomy] If pelvic lymphadenectomy is to be performed, which 4 nodal groups are included?

Answer 24

“ICE O

Internal iliac
common iliac
external iliac
obturator nodes”

Question 25

Should neoadjuvant cisplatin based combination chemotherapy be given prior to radical cystectomy? In what grade of disease?

Answer 25

Yes

Question 26

[Radical nephroureterectomy with cuff of bladder] Radical nephroureterctomy is the primary treatment option for what stage and grade of upper UUT tumors?

Answer 26

Should be NON METASTATIC | HIGH GRADE

Question 27

[Radical nephroureterectomy with cuff of bladder] For UUT tumors, single immediate post op intravesical chemo decreases __________.

Answer 27

INTRAVESICAL RECURRENCE

Question 28

[Radical nephroureterectomy with cuff of bladder] Most commonly used options for intravesical chemo:

Answer 28

MITOMYCIN | GEMCITABINE

Question 29

Male T2 primary carcinoma of the pendulous urethra can be treated with what surgical procedures?

Answer 29

"Distal urethrectomy or | Partial penectomy"

Question 30

A recurrent male T2 primary carcinoma of the pendulous urethra can be treated with what surgical procedure?

Answer 30

Total penectomy

Question 31

A female patient with T2 primary carcinoma of the urethra may be treated with what surgical procedure?

Answer 31

Urethrectomy and cystectomy

Question 32

What grade of upper GU tumors is regional lymphadenectomy indicated?

Answer 32

High grade

Question 33

What lymph node groups are included in left sided renal pelvic and upper ureteral tumors tumors?

Answer 33

Para aortic lymph nodes from the RENAL HILUM to the AORTIC BIFURCATION.

Question 34

What lymph node groups are included in midureteral tumors in left sided tumors?

Answer 34

``` "ECHO external iliac common iliac hypogastric obturator" ```

Question 35

What lymph node groups are included in right sided renal pelvic and upper ureteral tumors tumors?

Answer 35

Paracaval lymph nodes from the RENAL HILUM to the IVC BIFURCATION.