Stage II (cT2, N0)

Question 1

What are the additional workup that you will request for Stage II patients?

Answer 1

ABC

ABDOMINOPELVIC IMAGING
BONE SCAN AS NEEDED
CHEST IMAGING

Question 2

Two main categories for treatment in stage II patients?

Answer 2

CYSTECTOMY CANDIDATES

VS

NON-CYSTECTOMY CANDIDATES

Question 3

What are the FOUR main treatment options for Stage II patients?

Answer 3

• *1. NEOADJUVANT CISPLATIN BASED CHEMOTHERAPY THEN RADICAL CYSTECTOMY
  2. NEOADJUVANT CISPLATIN BASED CHEMOTHERAPY THEN PARTIAL CYSTECTOMY
  3. CYSTECTOMY ALONE
  4. CONCURRENT CHEMORAD**

Question 4

If partial cystectomy post neoadjuvant cisplatin based combination chemotherapy is to be chosen as the primary treatment option, what are the two conditions?

Answer 4

SOLITARY TUMOR IN A SUITABLE LOCATION, NO CARCINOMA IN SITU

Question 5

If concurrent chemoradiotherapy (BLADDER PRESERVATION) is to be chosen as the primary treatment option for stage II patients, what are the 3 prerequisites?

Answer 5

NO HYDRONEPHROSIS, NO EXTENSIVE OR MULTIFOCAL TIS, TUMOR IS LESS THAN 6CM

Question 6

Post radical/partial/cystectomy alone, what are the THREE conditions to consider adjuvant cisplatin based chemotherapy?

Answer 6

T3-T4 PRIMARY LESION, POSITIVE MARGINS, POSITIVE NODES

Question 7

Post radical/partial/cystectomy alone, adjuvant RT is an option for which subset of patients?

Answer 7

THOSE WHO DID NOT HAVE NEOADJUVANT TREATMENT REGIMEN

Question 8

After concurrent chemoradiotherapy, when will you reassess the tumor status?

Answer 8

2-3 months after full treatment

Question 9

After concurrent chemoradiotherapy, no tumor is found on reassessment, what is your next step?

Answer 9

observation

Question 10

After concurrent chemoradiotherapy, a tumor is found on reassessment, what are your THREE TREATMENT OPTIONS?

Answer 10

IF TA, T1, TIS - INTRAVESICAL CHEMO OR BCG

SURGICAL CONSOLIDATION

or TREAT AS METASTATIC DISEASE

Question 11

What are the THREE TREATMENT OPTIONS for Stage II patients who are NOT CANDIDATES FOR CYSTECTOMY?

Answer 11

CONCURRENT CHEMORAD IS PREFERRED AND CAT 1

RT

TURBT

Question 12

Of the THREE TREATMENT OPTIONS for Stage II patients who are NOT CANDIDATES FOR CYSTECTOMY, which is the PREFERRED CATEGORY 1 OPTION?

Answer 12

CONCURRENT CHEMORAD IS PREFERRED AND IS THE CAT 1 OPTION

Question 13

For Stage II patients who are not candidates for cystectomy, who underwent any of the 3 options above, a tumor was found, what are the FOUR OPTIONS for your patients?

Answer 13

SYSTEMIC THERAPY, CONCURRENT CHEMORAD OR RT ALONE, TURBT, BEST SUPPORTIVE CARE