Risk stratification

Question 1

low risk NICE

Answer 1

Urothelial cancer with any of:
• solitary pTaG1 with a diameter of less than 3 cm
• solitary pTaG2 (low grade) with a diameter of less than 3 cm
• any papillary urothelial neoplasm of low malignant

Question 2

intm risk NICE

Answer 2

Urothelial cancer that is not low risk or high risk, including:

• solitary pTaG1 with a diameter of more than 3 cm • multifocal pTaG1
• solitary pTaG2 (low grade) with a diameter of more than 3 cm • multifocal pTaG2 (low grade)
• pTaG2 (high grade) • any pTaG2 (grade not further specified)
• any low-risk non-muscle-invasive bladder cancer recurring within 12 months of last tumour occurrence

Question 3

NICE high risk

Answer 3

Urothelial cancer with any of: 
• pTaG3 
• pT1G2 
• pT1G3 
• pTis (Cis)
• aggressive variants of urothelial carcinoma, for example micropapillary or nested variants

Question 4

low risk EAU recurrence and progression 5 years

Answer 4

<1% progression

3.7% 10 years

Question 5

intm risk EAU progression

Answer 5

5% 5 years 8.5% 10 years

Question 6

high risk EAU progression

Answer 6

5 years = 10% 10 years =14%

Question 7

very high risk EAU progression

Answer 7

1 yera = 16%

5 years = 40%, 10 year =53%

Question 8

who 1973 eortc model factors

Answer 8

Number of tumours;
• Tumour diameter;
• Prior recurrence rate;
• T Category;
• Concurrent CIS;
• WHO 1973 tumour grade.

Question 9

factors for recurrence

Answer 9

Prior disease-recurrence rate and number of tumours were the most important prognostic factors for disease recurrence

Question 10

factors for progression

Answer 10

stage and grade were the most important prognostic factors for disease progression and disease-specific survival

Question 11

factors OS

Answer 11

while age and grade were the most important prognostic factors for overall survival (OS).

Question 12

low grade histology

Answer 12

well-defined papillary structures

• fibrovascular stalks covered by thickened urothelium (> 7-8 layers thick)
• rare or absent mitotic figures
• minimal cytologic atypia

Question 13

intermediate risk disease

Answer 13

recurrence risk based on number and recurrence

progression based on stage grade CIS

Question 14

NICE intermeidate risk advice cystoscopy

Answer 14

cystoscopy at 3,9,18 months then yearly thereafter

consider discharge after 5 years

Question 15

G3pT1 disease rule of 1/3

Answer 15

1/3 will die of met disease
1/3 will never recur
1/3 will have deferred RC

Question 16

CIS patient how many disease free at 5 years and 10 years

Answer 16

half and 1/3