Urethral cancer Flashcards
Clinical Vignette: A 52-year-old man presents with dysuria. He is diagnosed with T1 urethral cancer. What is the first-line treatment?
Options:
A. Partial urethrectomy
B. Radical cystectomy
C. Repeat TUR ± intraurethral BCG or chemotherapy
D. Neoadjuvant chemotherapy
Correct Answer:
C. Repeat TUR ± intraurethral BCG or chemotherapy
Explanation for All Choices:
A. Incorrect - Partial urethrectomy is not first-line for Tis, Ta, T1.
B. Incorrect - Radical cystectomy is recommended for female T2.
C. Correct - The guideline states Repeat TUR ± intraurethral BCG or chemotherapy for Tis, Ta, T1.
D. Incorrect - Neoadjuvant chemotherapy is a consideration but not first-line for these stages.
Memory Tool:
“Tea (T) One Repeat” – T1 involves Repeat TUR.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Understanding the first-line treatment options for various stages is crucial for optimal patient care.
Clinical Vignette: A 65-year-old man is diagnosed with T2 urethral cancer in the pendulous urethra. What is the recommended first-line treatment?
Options:
A. Radical cystectomy
B. Partial urethrectomy ± penectomy
C. Chemoradiotherapy
D. Repeat TUR
Correct Answer:
B. Partial urethrectomy ± penectomy
Explanation for All Choices:
A. Incorrect - Radical cystectomy is not for male T2 pendulous urethra.
B. Correct - Partial urethrectomy ± penectomy is the first-line treatment for male T2 pendulous urethra.
C. Incorrect - Chemoradiotherapy is a potential adjuvant therapy, not first-line.
D. Incorrect - Repeat TUR is for earlier stages (Tis, Ta, T1).
Memory Tool:
“Pendulous Pen-ectomy” – Pendulous urethra cases may include penectomy.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Knowing specific treatments for sublocations like the pendulous urethra is vital for tailored care.
Clinical Vignette: A patient has a T2 urethral cancer, and postoperative pathology reports indicate a positive margin. What is the adjuvant therapy?
Options:
A. Additional surgery
B. Neoadjuvant chemotherapy
C. Radiotherapy alone
D. All of the above
Correct Answer:
A. Additional surgery
Explanation for All Choices:
A. Correct - If there’s a positive margin, additional surgery is an option.
B. Incorrect - Neoadjuvant chemotherapy is not specifically recommended for positive margins.
C. Incorrect - Radiotherapy alone is not recommended for positive margins.
D. Incorrect - Additional surgery is the only listed adjuvant therapy for positive margins.
Memory Tool:
“Positive Margin? Add Surgery” – Additional surgery is an option for positive margins.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Recognizing adjuvant therapy options for positive margins aids in comprehensive patient treatment.
Clinical Vignette: A 55-year-old man with a history of smoking is diagnosed with T2 urethral cancer located in the bulbar urethra. What is the first-line treatment?
Options:
A. Radical cystectomy
B. Urethrectomy ± radical cystectomy
C. Chemoradiotherapy
D. Repeat TUR
Correct Answer:
B. Urethrectomy ± radical cystectomy
Explanation for All Choices:
A. Incorrect - Radical cystectomy is indicated for Female T2.
B. Correct - Urethrectomy ± radical cystectomy is the first-line treatment for male T2 in the bulbar urethra.
C. Incorrect - Chemoradiotherapy can be an adjuvant therapy, not first-line.
D. Incorrect - Repeat TUR is indicated for Tis, Ta, T1 stages.
Memory Tool:
“Bulbar = Both” – Bulbar urethra may involve urethrectomy and cystectomy.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Understanding specialized treatments for different anatomical locations like the bulbar urethra is crucial for patient-specific management.
Clinical Vignette: A 67-year-old female is diagnosed with T2 urethral cancer. What are the treatment options?
Options:
A. Urethrectomy ± radical cystectomy
B. Radical cystectomy OR Chemoradiotherapy
C. Repeat TUR ± intraurethral BCG or chemotherapy
D. Chemoradiotherapy ± consolidative surgery
Correct Answer:
B. Radical cystectomy OR Chemoradiotherapy
Explanation for All Choices:
A. Incorrect - This is indicated for Male T2 Bulbar urethra.
B. Correct - For Female T2, radical cystectomy or chemoradiotherapy is recommended.
C. Incorrect - This is for Tis, Ta, T1 stages.
D. Incorrect - This is for stages ≥ T3, N0 or N+.
Memory Tool:
“Two Ts, Two Choices” – For Female T2, you have two main choices: Radical cystectomy OR Chemoradiotherapy.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Being aware of gender-specific recommendations aids in individualized patient treatment.
Clinical Vignette: A patient has been diagnosed with pT3 urethral cancer. What is the adjuvant therapy?
Options:
A. Neoadjuvant chemotherapy
B. Chemoradiotherapy OR Chemotherapy
C. Additional surgery
D. Radiotherapy alone
Correct Answer:
B. Chemoradiotherapy OR Chemotherapy
Explanation for All Choices:
A. Incorrect - Neoadjuvant chemotherapy is a consideration, not an adjuvant therapy for ≥ pT3 or N+.
B. Correct - Chemoradiotherapy OR Chemotherapy are listed adjuvant therapies for these stages.
C. Incorrect - Additional surgery is an option for positive margins, not for ≥ pT3 or N+.
D. Incorrect - Radiotherapy alone is not indicated for this stage.
Memory Tool:
“3+ Therapy Choices for pT3” – pT3 can have Chemoradiotherapy OR Chemotherapy as an option.
Reference Citation:
Data from Bladder Cancer, NCCN Clinical Practice Guidelines in Oncology, 2018
Rationale:
Different stages have specific adjuvant therapies, and it’s crucial to know them for effective management.
