Bladder Flashcards
(33 cards)
What are some familial syndromes and genes associated with bladder cancer?
- Lynch
- Peutz-Jeghers
- Li-Fraumeni
- Neurofibromatosis
- Cowden
GENES
- N-acetyltransferases (NAT1 and NAT2 genes)
- glutathione S-transferases
What are some malignant markers of bladder cancer?
- most common is loss of chromosome 9 (esp. 9q)
- p16 - > 50% of all bladder CA, squamous.
- p53 - high grade, assoc. with CIS
- RB - aggressive, assoc. with CIS
- PTEN - assoc. with CIS
- p27 - aggressive
- RAS
- Ki-67 - aggressive
- FGFR3 - low grade, low malignant potential Ta
How would you stage a urothelial cancer that is a direct invasion through the bladder and into the prostatic stroma
T4
How would you stage a tumor that it’s in the prostatic urethra
T2 urethral
What is BCG Refractory
Persistent disease in 6 months or progression at 3 months
What is BCG Relapse
Recurrence after treatment (12 months or later)
What are the indications for 2nd look re-resection?
- Incomplete tumor resection
- high grade Ta or T1
- Large (>3cm) or multifocal tumor
What’s the percent of upstaging on re-resection
15% for Ta
30% for T1
What is the percent of persistent disease on re-resection?
48%
What are the rates of recurrence and progression for T1 and CIS?
RECURRENCE: 80% for both
PROGRESSION: 50% for T1, 40-80% for CIS
What is considered low risk bladder cancer?
PUNLUMP,
Low grade Ta < 3cm
What is considered intermediate risk bladder cancer?
Low grade Ta > 3cm Multifocal low grade Ta Recurrent low grade Ta in < 1 year High grade Ta < 3cm Low grade T1
What is considered high risk bladder cancer?
High grade Ta > 3cm Multifocal high grade Ta Recurrent high grade Ta High grade T1 CIS Multivariant LVI high grade prostatic involvement any BCG failure
what is the purpose of peri-operative intravesical chemotherapy?
Reduce the recurrence rate by 35%
Who should get peri-operative intravesical chemotherapy?
Low or intermediate risk
What is the recommended regimen for maintenance BCG?
3 week cycles at month 3, 6, 12, 18, 24, 30, 36
what is the purpose of peri-operative intravesical chemotherapy?
To prevent recurrence and progression of disease
What is BCG unresponsive?
- BCG refractory (persistent)
2. BCG relapse within 6 months (recur)
What is the surveillance schedule for low risk bladder cancer?
No cytology
No imaging
Cysto: 3, 12, then annual
What is the surveillance schedule for intermediate risk bladder cancer?
Imaging Q1-2y
Cytology
Cysto: 3, then 3-6mo x 2y, then 6-12mo x 2y, then annual
What is the surveillance schedule for high risk bladder cancer?
Imaging Q1-2y
Cytology
Cysto: Q3mo x 2 yr, Q6mo x 2 year, then annual
What is the purpose of enhanced cystoscopy
- Increase detection
2. Reduce recurrence
What are the indications for immediate cystectomy?
- Variant histology
- LVI
- Persistent T1 on re-resection (no BCG)
- BCG failure
How do you treat BCG sepsis?
isoniazid, rifampin, ethambutol +/- steroids
