Bladder Cancer (+ UTUC and Urethral Cancer)

Bladder Cancer Presentation

Bladder Cancer Risk Factors

Presentation

TURBT Checklist, Anderson et al.

Obtaining Bladder Cancer Diagnosis

TURBT Tips

Post-TURBT intravesical chemotherapy

Repeat TURBT

UTUC Workup

Bladder TNM Staging, from Campbell's

Urachal cancer staging per Sheldon 1984

Bladder pathologies

NMIBC vs MIBC

Non-malignant TURBT findings

Premalignant and recurrent TURBT findings

Variant Histology

Non-Urothelial Bladder Cancers

NMIBC risk classification, from AUA NMIBC Guidelines

NMIBC risk of recurrence and progression, from Campbell's


EORTC risk tables, from Sylvester et al

Management of positive cytology, from Campbell's

Non-Muscle Invasive Bladder Cancer (AUA management algorithm)

Risks of Recurrence and Progression

Low risk recommendations

Intermediate risk recommendations

High risk recommendations

Recurrences (intermediate/high risk)

Up-Front Cystectomy

Prostatic urethral cancer

BCG

Types

Administration and success

Risks/side effects

  • Contraindications: immunocompromised patients, prior BCG sepsis, gross hematuria, traumatic catheterization, incontinence
  • Side effects: dysuria, hematuria, fever (5%), BCG sepsis (0.5%)
  • 70% report some side effects, 8% need to stop therapy
  • BCG Grade 1 toxicity: obtain UCx, manage symptoms
  • BCG Grade 2 toxicity (symptoms > 48hrs) obtain UCx + CXR + LFTs, treat with rifampin + isoniazid, consider dose reduction and pretreating with isoniazid prior to BCG administration
  • BCG Grade 3 toxicity (allergy or solid organ involvement): isoniazid + rifampin, stop BCG, consider ID consult
  • BCG failures

    Other NMIBC Therapies

    Mitomycin (MMC)

    Doxorubicin/Epirubicin

    Gemcitabine

    Pembrolizumab

    Other immunotherapies

    Postop nomogram to predict recurrence, from Karakiewicz et al

    Postop monogram to predict recurrence (including biomarkers), from Shariat et al

    Muscle Invasive Bladder Cancer (AUA management algorithm)

    Considerations

    Neoadjuvant Chemotherapy

    Bladder preserving therapies

    Metastatic Bladder Cancer

    Cystectomy

    Adjuvant therapy

    Post-Cystectomy prognosis

    Urethral recurrence after cystectomy

    Probability of non-organ confined disease, from Margulis et al

    Upper Tract Urothelial Carcinoma (UTUC)

    UTUC by the numbers

    Risk Factors

    Workup

    Organ-sparing management

    Nephroureterectomy

    Male urethra and associated cancer pathology, from Campbell's

    TNM staging for urethral cancer, from Campbell's

    NCCN treatment recommendations for urethral cancer, from Campbell's

    NCCN treatment recommendations for localized prostatic urethral cancer, from Campbell's

    Urethral Tumors

    Benign tumors

    Male urethral cancer

    Female urethral cancer

    Chemotherapy

    References