Devita, Hellman, and Rosenberg's Cancer

LWBK1006-21 LWW-Govindan-Review December 12, 2011 19:6

290 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

specimen in patients diagnosed with superficial bladder cancer contains

muscle to determine whether there is an non-invasive component. Most,

but not all, studies have suggested that intravesical BCG is more effec-

tive than intravesical chemotherapy. Although other chemotherapeutic

agents are being investigated, cyclophosphamide needs to be activated to

4-hydroxy-cyclosphosphamide in the liver to act as an alkylating agent,

and thus bladder instillation of the parent compound is not expected to be

effective. Radiation or cystectomy, although potentially useful for inva-

sive carcinoma or refractory bladder cancer, is not appropriate as initial

therapy in this patient.

Answer 21.10. The answer is D.

Patients with muscle-invasive bladder cancer require definitive local ther-

apy. Additional intravesical therapy is inappropriate. Partial cystectomies

are only rarely indicated and should be performed in only a very highly

select group, which does not include patients with a history of T cis or

patients with multiple tumors. The standard definitive therapy for bladder

cancer is cystectomy. Multiagent cisplatin-based neoadjuvant chemother-

apy improves survival for patients with invasive urothelial bladder cancer

and is considered a standard of care.

Answer 21.11. The answer is D.

Chromosomal translocations fusing the TMPRSS2 androgen-responsive

gene to various ETS family transcription factors, of which ERG is the

most common, occur in approximately 60% of patients. Prostate cancer

is characterized by a relatively low rate of mutations in KRAS, BRAF, and

p53, unlike most other tumors.

Answer 21.12. The answer is D.

Risk factors for male urethral cancers include HPV-16, chronic irritation,

and infection. The incidence of urethral cancer in men with urethral stric-

tures ranges from 24% to 76%. No racial predisposition has been noted

for urethral cancers.

Answer 21.13. The answer is C.

There are several options for urinary diversion after cystectomy, and no

clear evidence has emerged that any is more or less desirable or effective

based on patient gender. Diversion to the abdominal wall with a urostomy

can be performed as a conduit, requiring a urine collection device, or as

a continent diversion, requiring regular catheterization. Metabolic com-

plications, including metabolic acidosis, can occur with both conduits and

continent diversions. Complications of orthotopic continent diversions,

or neobladders, include intermittent urethral obstruction and frequent

requirement for intermittent or temporary self-catheterization.

Answer 21.14. The answer is B.

Organ preservation with combined radiation and chemotherapy has been

investigated in numerous trials, and long-term outcomes are similar to