Urothelial Cancer

Question 1

Describe T3 urothelial cancer?

Answer 1

Invasion of perivesical tissues

Question 2

Describe T4 urothelial cancer

Answer 2

Invasion of surrounding structure

Question 3

Options for NACT in urothelial cancer?

Answer 3

Cisplatin and gemcitabine or dose dense or non dose dense MVAC.

Question 4

Contraindications to cisplatin?

Answer 4

GFR <60ml/min, >G2 hearing loss, >G2 peripheral neuropathy, known cardiac failure

Question 5

What is the absolute increase in OS with NACT for urothelial cancer?

Answer 5

5% AT 5 YEARS

Question 6

What is the role of adjuvant therapy post NACT + cystectomy with lymph node dissection

Answer 6

Nivolumab given in presence of residual disease and positive PDL1

Question 7

What is the role of adjuvant therapy in upper tract urothelial cancers?

Answer 7

Significant DFS benefit, typically gemcitabine and cisplatin but carboplatin used if cisplatin ineligible.

Question 8

mOS with use of cis/gem in first line for metastatic disease?

Answer 8

10-14m

Question 9

First line management of PDL1 positive (PDL1 >5%) metastatic urothelial cancer

Answer 9

Pembrolizumab or atezolizumab or can give in second line following chemotherapy (regardless of PDL status). Can be given in PS 2. Good for patients who are Cisplatin ineligible.

Question 10

What maintenance treatment can be given following completion of first line platinum based chemotherapy for metastatic urothelial cancer?

Answer 10

Avelumab

Question 11

A mutation in which gene is suggestive of plasmacytoid urothelial carcinoma?

Answer 11

CDH1, rare and aggressive variant

Question 12

What is the rate of recurrence for high grade T1 bladder cancers at 5 years?

Answer 12

Around 40-50%

Question 13

What is the best treatment for non muscle invasive urothelial carcinoma of the bladder following transurethral resection?

Answer 13

Mitomycin C