Cancer ESMO Summit Africa 2019 Dr Benita Stoltz University of - - PowerPoint PPT Presentation

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Cancer ESMO Summit Africa 2019 Dr Benita Stoltz University of - - PowerPoint PPT Presentation

Jul 25, 2023 983 likes •1.16k views

Bladder Cancer ESMO Summit Africa 2019 Dr Benita Stoltz University of Pretoria Dr Riette Burger University of Stellenbosch Case presentation 52yr old male, Social history: 20 pack year smoking Symptoms: history, no alcohol

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Bladder Cancer

ESMO Summit Africa 2019 Dr Benita Stoltz

University of Pretoria

Dr Riette Burger

University of Stellenbosch

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Case presentation

  • 52yr old male,
  • Symptoms:

Dysuria, macro- haematuria, urgency and dribbling.

  • Past medical history:

HIV negative, no medical comorbidities.

  • Social history: 20

pack year smoking history, no alcohol use, good family support.

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Presentation

Abdominal ultrasound Bladder mass causing left hydronephrosis  JJ stent was placed Examination: PS 1, unremarkable general examination Chest – clear Abdomen – no masses or organomegaly No distant lymph nodes, no pallor Cystoscopy: Bladder mass extending from the bladder neck covering both ureteral orifices, L>R.

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TURBT

Transurethral Resection of Bladder Tumour:

  • Histology: Infiltrating high grade urothelial carcinoma,

muscularis propria invasion present

  • Sections from the prostatic urethra showed infiltration
  • Random bladder biopsies negative for carcinoma
  • No lympho-vascular invasion

T2b

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Investigations

Blood Results: Na 134, K 5.0, Urea 5.1, Creatinine 154, normal FBC and LFT. Nuclear Medicine GFR Measurement: Corrected GFR 60ml/min CT Scan: Thickened bladder wall Lymphadenopathy:

  • right external (23mm) and internal iliac
  • left internal iliac
  • para-aortic (multiple, 8mm, loss of fatty hilum, all

below renal vessels) Suspicious lung nodule left upper lobe 3,9 X 3,2mm

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CT Scan

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CT Scan

Stage T2bN2M1a – Stage IVA OR T2bN2M1b – Stage IVB

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Treatment Decision - Chemotherapy

3 Cycles Cisplatin / Gemcitabine, Cisplatin 70mg/𝑛2 D1, Gemcitabine 1000mg/𝑛2 D1 & D8 3-weekly Grade 1 side effects responding to medical management

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Re-staging Investigation

CT Scan: Less pronounced bladder wall thickening Significant reduction in size of iliac lymph nodes (near complete resolution) Para-aortic nodes also smaller and less in number Lung unchanged, most likely benign granuloma Stage T2bN2M1a – Stage IVA

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CT Scan

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CT Scan

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Treatment - Surgery

Radical cystoprostatectomy and lymph node dissection 3 X 3cm tumour of the trigone High grade invasive urothelial carcinoma Infiltrates lamina propria, but no residual tumour in deep muscle Tumour free margin > 2cm No LVI or PNI Normal urethra, prostate and seminal vesicles Lymph nodes dissection included pelvic and para-aortic nodal dissection: Left 0/7, Right 1/5 (external iliac node)

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Questions

Role of cysto-prostatectomy in stage IVA bladder cancer? Was para-aortic nodal dissection of benefit? Was adjuvant chemotherapy or chemoradiotherapy indicated? Role of PD-1 inhibitors?

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Special Thanks

Dr R Burger, consultant at Tygerberg Hospital as my supervisor, Prof H Simonds and the Department of Oncology at Tygerberg Hospital.

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References

Medscape Guidelines https://emedicine.medscape.com/article/438262-overview K Bowa, C Mulele, J Kachimba, E Manda, V Mapulanga, S Mukosa. A review of bladder cancer in Sub-Saharan Africa: presentation, assessment and treatment. Review article. 2018 Vol 17.