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CC Nov 2017 Bladder cancer

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echoecho's version from 2017-11-27 17:59

Section

Question Answer
At present, how many cases of bladder cancer are diagnosed each year worldwide, with more than how many deaths per year?430,000; 150,000
In the US, how many new cases were diagnosed in 2016 with how many deaths?76,000; 16,300
Bladder cancer is the ____th common cancer among men and the ____th most common cause of cancer death?4th; 8th
Bladder cancer is more commonly found in what gender with what ratio?Men; 3:1 ratio
What ethnicity is it more common compared to African Americans?caucasians
80% of bladder cancers are diagnosed after the age of ____ with a median age at diagnosis of ____ y.o.?60; 70
*** What is the greatest risk factor?smoking (cigarettes, cigar and pipe smoking)
*** Risk among current smokers increased by ___ to ___ fold when compared to non smokers?3; 4
Smoking accounts for about ____% of the risk of bladder cancer?15
Smoking cessation decreases the risk of bladder cancer, but it remains increased compared with never smokers at ____ year follow-up?20
What carcinogenic chemical compounds in cigarette smoke have been clearly linked to bladder cancer?1) aromatic amines 2) polyaromatic hydrocarbons
These chemicals are also seen in what occupational exposure workers?1) metal workers 2) painters 3) rubber industry 4) miners 5) hairdressers 6) firefighters
Industrial/occupational chemical exposures are thought to account for ___ to ___% of all bladder cancers?10; 20
List other factors associated with bladder cancer?1) dehydration (increased concentration of urinary carcinogens) 2) chronic cystitis 3) HPV infection 4) radiation therapy to the pelvis 5) exposure to cyclophosphamide therapy (which conveys as high as a 9- fold increased risk)
Is screening for bladder CA recommended even in high-risk patients?no
The positive predictive value of microhematuia is just ___% for urothelial bladder cancer, the most common histology can type (formerly known as transitional cell carcinoma) and urine cytology testing is positive in only ___% of patients with bladder cancer?6%; 10%
Nonurothelial histology accounts for only ___% of bladder cancer, including what 3 types of cancer?1) squamous cell 2) adenocarcinoma 3) small cell cancer
The use of urinary biomarkers is promising but has this reduced the risk of bladder cancer deaths in the initial screening studies?no
*** What is the most common presenting complaints in patients with bladder cancer?intermittent, painless, gross hematuria
What other symptoms can accompany hematuria or may be an initial symptom of bladder cancer?frequency, urgency, dysuria
What are other causes of hematuria?UTI, kidney disease, kidney stones and rarely renal or urethral cancer
*** A man > 40 years of age with gross, painless hematuria should be considered to have _________ cancer until proven otherwise?urothelial
What symptoms are more commonly associated with metastatic disease?back or pelvic pain, constitutional symptoms (anorexia, weight loss, fatigue)
What procedure is the gold standard for diagnosis of bladder cancer?cystoscope
Urine collected and sent for ______ evaluation as part of this procedure?cytological
Why is repeat cystoscope indicated if symptoms persist?because about 10% of bladder lesions can be missed
What procedure is a technique that has reduced false-negative cystoscope to < 3% but is not generally an office procedure?fluorescence cystoscopy
What is the cystoscopy biopsy looking for?tumor grade and muscle invasion
Low-grade tumors appear what?Papillary with a narrow stalk
Aggressive cancers are what?sessile and modular
Why should biopsies of the apparently uninvolved ares of the bladder should be done, why?because in the setting of carcinoma in situ, which can be multi focal
What imaging studies should be done to evaluate for metastatic disease?1) abdominal and pelvic CT with and without cancer OR 2) MRI with gadolinium 3) CXR to screen for lung metastasis
Why is PET/CT not very useful in identifying mestastatic disease?it is not useful in defining the extent of local disease in the pelvis due to the urinary excretion of F18-fluorodeoxyglucose
70-75% of all bladder cancers are low grade and not muscle invasive, true or false?true
These tumors are respected via cystoscopy and treated how? Comment on recurrence rates?1) intravesical administration of chemotherapy (mitomycin, gemcitabine, taxanes) 2) recurrences rates are high (40-80% at 12 months) and progression to high-grade, muscle-invasive disease occurs in about 15% of patients.
Do patients with superficial low-grade bladder cancer need evaluation for mestastic disease?no
Which patient types have increased risk of muscle invasive disease and many patients are treated with cystectomy?1) carcinoma in situ 2) high-grade, multifocal tumors 3) invasion of lamina propria
High-grade, muscle-invasive urothelial cancer of the bladder represents ___ to ___% of all bladder cancers?20; 30
What is the 5-year survival for pathologically organ-confined urothelial cancer of the bladder (Grade T2 - into muscle but not serousa) is ____%?68
If the serous or an adjacent organ are infiltrated (Grade T3-4) or if pelvic lymph nodes are involved, the 5-year survival is ___ to ___%?25; 30
What procedure is the most appropriate approach to muscle invasive cancer?radical cystectomy with new adjuvant chemotherapy or postoperative chemotherapy
Bladder-sparing approaches include what?maximal transurethral resection combined with chemotherapy and radiation
Surveillance after treatment involves repeat cystoscopy at ___ month intervals for a year, then at increasingly longer intervals over time?3
Urine cytology, kidney and liver function studies and CT scans may be performed as clinically indicated, usually beginning at ___ month interval?6
Metastatic bladder cancer has a 5 year survival rate of ___ to ___%?10-15%
What are the most common sites of metastatic bladder cancer spread?1) nodes 2) lungs 3) bone
What are the most common drugs utilized? Is it uncommon for patients to receive 3-4 lines of therapy with extension of survival and maintenance of quality of life?1) cisplatin 2) gemcitabine 3) paclitaxel 4) methotrexate 5) no it is not uncommon
*** What can be used in patient with organ-confined bladder cancer with significant co-morbidities and often not candidates for radical cystectomy?1) the use of radiation with concurrent chemotherapy (cisplatin or 5-flurouracil) after transurethral resection has resulted in rates of local/regional disease-free survival of 65-70% vs 50-55% with radiation alone
Side effects of cisplatin or 5-flurouracil side effects are what?GI toxicity (temporary and manageable)
True or false? Bladder cancer is another example of a malignancy where co-operation between family physicians, urologist, radiation and medical oncologists result in the best outcome for the patient?true
*** SUMMARY = What is the most common urologic cancer?bladder CA
*** SUMMARY = What are the most common presenting complaint?intermittent, painless, gross hematuria
*** SUMMARY = Smoking accounts for about ___% of bladder cancer risk?50
*** SUMMARY = What is the gold standard diagnostic test for bladder cancer?cystoscopy
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