Muscle-invasive bladder cancer Flashcards
When should a lymph node be regarded as pathological on CT and MRI?
pelvic lymph nodes > 8mm
abdominal lymph nodes > 10 mm short axis diameter
How often does a FDG-PET-CT influence the treatment of muscle-invasive bladder cancer?
20% of patients
How often does a PDG-PET-CT change the tretment plan for high risk muscle-invasive bladder cancer?
28% of patients
What types of urinary diversions are there?
Orthotopic neobladder ( best if ileum i used)
Ileal conduit
Ureterocutaneostomy
Continent cutaneous diversion (mainz pouch, indian pouch)
What patients can be considered for pelvic organ-preserving cystectomy (nerve-sparing)?
organ-confined disease
abscenceo f tumour in bladder neck or urethra
What are the evindence-based perioperative measures at redical cystectomy?
No bowel preparation
Restrictive fluid adminstration during surgery
Peritoneal readaptation
Multiple measures to avoid paralytic ileus
ERAS
Why should you not use bowel preparation before a radical cystectomy if small bowel is used for reconstruction?
it increases histological oedema in small bowel wall
What are the benefits of readaptation of the peritoneum after a cystectomy?
Less postoperative pain
Earlier intestinal transit
Fewer complications
What are the rationale for Adjuvant therapy in muscle-invasive bladder cancer?
Deal with the “bladder”problem immediately
Chemotherapy decisions based on true pathology
No compromise of local therapy due to toxicites
No delay in definitive locan therapy
Surgery will act as a stress test for the tolerance for chemotherapy
What are the rationale for NeoAdjuvant therapy in muscle-invasive bladder cancer?
Give systemic therapy when pelvic blood supply is intact
Patiens are more fit and better able to tolerate chemotherapy
In vivo shemo-sensivity test
Deal with micrometastatic disease immediately
Might fascilitate surgery by decressing tumour mass
Radical cystectomy complications might delay adjuvant therapy
Patients commonly refuse adjuvant therapy after radical cystectomy
How much does chemotherapy improve 5-year-survival in muscle-invasive bladder cancer?
5%
When should NeoAdjuvant chemotherapy be offered in muscle invasive bladder cancer?
T2-T4aN0M0
What kind of chemotherapy should be used for muscle-invasive bladder cancer?
cisplatin-based combination therapy
What immunesystemic factors can be prognostic for bladder cancer?
PD-L1 expression
CD8 tumour-infiltrating lymphocytes in the primary tumour
Which PD-L1 inhibitor has level 1 evidence for use against muscle invasive bladder cancer in patients who are cisplatin unfit?
Pembrolizumab (keytruda)
