ESMO Guidelines for Bladder Cancer
Management Questions With 100%
Pass
/. What is the most common presenting symptom of bladder cancer? - Answer-
✅Painless haematuria.
/.What diagnostic procedure is essential for confirming bladder cancer? - Answer-
✅Cystoscopic examination of the bladder.
/.What are the key imaging techniques used to detect bladder cancer? - Answer-
✅Bladder ultrasonography, computed tomography (CT) urography, and magnetic
resonance imaging (MRI) urography.
/.What is the most significant risk factor for developing bladder cancer? - Answer-
✅Tobacco smoking, accounting for approximately 50% of cases.
/.What is the estimated number of new bladder cancer cases worldwide in 2018? -
Answer-✅549,000 new cases.
/.Which regions in Europe have the highest incidence rates of bladder cancer? -
Answer-✅Southern Europe (e.g., Greece, Spain, Italy) and Western Europe (e.g.,
Belgium, Netherlands).
/.What is the role of lamina propria and detrusor muscle in bladder cancer staging? -
Answer-✅Their presence in the resected specimen is essential for accurate staging.
/.What is the significance of concurrent carcinoma in situ (CIS) in bladder cancer? -
Answer-✅It is an adverse prognostic factor.
/.What is the classification system used for staging muscle-invasive bladder cancer
(MIBC)? - Answer-✅The Union for International Cancer Control (UICC) TNM eighth
edition and the American Joint Committee on Cancer (AJCC) TNM staging systems.
/.What should be performed in patients with high-risk non-muscle-invasive bladder
cancer (NMIBC)? - Answer-✅Upper tract imaging to screen for synchronous upper
urinary tract urothelial carcinoma (UTUC).
,/.What type of biopsy should be taken from suspicious urothelium in bladder cancer
diagnosis? - Answer-✅Bladder biopsies from suspicious urothelium or mapping
biopsies from normal-looking mucosa.
/.What are common symptoms of bladder cancer besides painless haematuria? -
Answer-✅Dysuria, increased frequency, and/or urgency.
/.What is the estimated number of bladder cancer deaths worldwide in 2018? - Answer-
✅200,000 deaths.
/.What is the role of pathological findings in the management of bladder cancer? -
Answer-✅Management is based on the biopsy's histology, grade, and depth of
invasion.
/.What is the classification of bladder cancer referred to in the guidelines? - Answer-
✅Urothelial carcinoma (UC), also described as bladder cancer.
/.What are the common occupational exposures that increase the risk of bladder
cancer? - Answer-✅Exposure to aromatic amines and ionising radiation.
/.What is the importance of complete resection of tumor tissue in bladder cancer? -
Answer-✅It should be achieved when possible for accurate diagnosis and staging.
/.What is the recommended follow-up for patients with a history of high-grade non-
muscle-invasive bladder cancer? - Answer-✅Regular monitoring and imaging to detect
any recurrence or progression.
/.What is the role of immune checkpoint inhibitors in bladder cancer treatment? -
Answer-✅They are part of the evolving treatment landscape for bladder cancer.
/.What is the significance of antibody drug conjugates in bladder cancer? - Answer-
✅They represent a novel therapeutic approach in the treatment of bladder cancer.
/.What is the primary goal of the ESMO Clinical Practice Guidelines for bladder cancer?
- Answer-✅To provide evidence-based recommendations for diagnosis, treatment, and
follow-up.
/.When were the ESMO Clinical Practice Guidelines for bladder cancer made available
online? - Answer-✅30 November 2021.
/.What is the role of transurethral resection of the bladder tumor (TURBT) in bladder
cancer? - Answer-✅It is used for obtaining tissue for histological evaluation.
,/.What is the relationship between bladder cancer and the presence of high-grade non-
muscle-invasive bladder cancer (NMIBC)? - Answer-✅Patients with a history of high-
grade NMIBC are at increased risk for recurrence and progression.
/.What is the primary symptom of bladder cancer experienced by 80% of patients? -
Answer-✅Painless haematuria.
/.What irritative symptoms may indicate invasive or high-grade tumors in bladder
cancer? - Answer-✅Dysuria, frequency, and urgency.
/.What types of pain might suggest bone metastasis or retroperitoneal metastases in
bladder cancer patients? - Answer-✅Bone pain or flank pain.
/.What are the key components of the work-up for suspected bladder cancer? - Answer-
✅History and physical examination, cystoscopic evaluation with biopsy or TURBT, urine
cytology, blood work, upper urinary tract imaging, and metastatic work-up.
/.What imaging technique is primarily used for upper urinary tract evaluation in bladder
cancer? - Answer-✅CT urogram.
/.What percentage of patients with bladder cancer present with non-muscle invasive
bladder cancer (NMIBC)? - Answer-✅Approximately 75%.
/.What are the classifications for muscle invasive bladder cancer (MIBC) according to
staging? - Answer-✅pT2a-pT4b.
/.What is the grading system for non-muscle invasive bladder cancer (NMIBC)
according to WHO 2016 criteria? - Answer-✅Graded as low grade (LG) or high grade
(HG).
/.What is the sensitivity of urine cytology in high-grade tumors including carcinoma in
situ (CIS)? - Answer-✅84%.
/.What is the sensitivity of urine cytology in low-grade tumors? - Answer-✅16%.
/.What is the role of TURBT in the staging of bladder cancer? - Answer-✅It allows for
staging up to T2.
/.What should be specified in the pathological report if small-cell/neuroendocrine
subtypes are present? - Answer-✅The percentage of these subtypes.
/.What oncogenic alteration is mentioned in the context of advanced bladder cancer? -
Answer-✅Fibroblast growth factor receptor (FGFR) DNA alterations.
, /.What type of therapy is being investigated for advanced bladder cancer? - Answer-
✅Immuno-oncology therapy biomarker testing.
/.What is the significance of programmed death-ligand 1 (PD-L1) expression in bladder
cancer? - Answer-✅It is used for patient selection in immuno-oncology therapy.
/.What is the WHO classification year referenced for pathological diagnosis in bladder
cancer? - Answer-✅2016
/.What is the recommended follow-up for clinicians regarding PD-L1 measurement? -
Answer-✅Follow European Medicines Agency (EMA) guidance.
/.What is the implication if squamous or adenocarcinoma components exceed 95% in a
tumor? - Answer-✅The tumor should be considered a pure squamous or
adenocarcinoma.
/.What is the primary method for histological diagnosis of bladder cancer? - Answer-
✅Cystoscopic evaluation and biopsy.
/.What is the purpose of the bimanual examination in bladder cancer diagnosis? -
Answer-✅To identify clinical T3 or T4 disease.
/.What is the publication date of the ESMO Guidelines referenced in the notes? -
Answer-✅November 2021.
/.What is the significance of Supplementary Tables S1, S2, and S3 mentioned in the
document? - Answer-✅They provide additional information related to the management
and classification of bladder cancer.
/.What are the characteristics of low-risk tumours in NMIBC? - Answer-✅Primary,
solitary, Ta G1 (PUNLMP, LG), <3 cm, no CIS.
/.What is the treatment recommendation for low-risk tumours after TURBT? - Answer-
✅One immediate instillation of intravesical chemotherapy followed by cystoscopic
surveillance.
/.How are intermediate-risk tumours defined in NMIBC? - Answer-✅All tumours not
defined in the low or high-risk categories.
/.What are the treatment options for intermediate-risk tumours? - Answer-✅Full-dose
BCG instillations for 1-3 years or radical cystectomy; immediate instillation of
intravesical chemotherapy for patients with low recurrence rates and expected EORTC
recurrence score <5.
Management Questions With 100%
Pass
/. What is the most common presenting symptom of bladder cancer? - Answer-
✅Painless haematuria.
/.What diagnostic procedure is essential for confirming bladder cancer? - Answer-
✅Cystoscopic examination of the bladder.
/.What are the key imaging techniques used to detect bladder cancer? - Answer-
✅Bladder ultrasonography, computed tomography (CT) urography, and magnetic
resonance imaging (MRI) urography.
/.What is the most significant risk factor for developing bladder cancer? - Answer-
✅Tobacco smoking, accounting for approximately 50% of cases.
/.What is the estimated number of new bladder cancer cases worldwide in 2018? -
Answer-✅549,000 new cases.
/.Which regions in Europe have the highest incidence rates of bladder cancer? -
Answer-✅Southern Europe (e.g., Greece, Spain, Italy) and Western Europe (e.g.,
Belgium, Netherlands).
/.What is the role of lamina propria and detrusor muscle in bladder cancer staging? -
Answer-✅Their presence in the resected specimen is essential for accurate staging.
/.What is the significance of concurrent carcinoma in situ (CIS) in bladder cancer? -
Answer-✅It is an adverse prognostic factor.
/.What is the classification system used for staging muscle-invasive bladder cancer
(MIBC)? - Answer-✅The Union for International Cancer Control (UICC) TNM eighth
edition and the American Joint Committee on Cancer (AJCC) TNM staging systems.
/.What should be performed in patients with high-risk non-muscle-invasive bladder
cancer (NMIBC)? - Answer-✅Upper tract imaging to screen for synchronous upper
urinary tract urothelial carcinoma (UTUC).
,/.What type of biopsy should be taken from suspicious urothelium in bladder cancer
diagnosis? - Answer-✅Bladder biopsies from suspicious urothelium or mapping
biopsies from normal-looking mucosa.
/.What are common symptoms of bladder cancer besides painless haematuria? -
Answer-✅Dysuria, increased frequency, and/or urgency.
/.What is the estimated number of bladder cancer deaths worldwide in 2018? - Answer-
✅200,000 deaths.
/.What is the role of pathological findings in the management of bladder cancer? -
Answer-✅Management is based on the biopsy's histology, grade, and depth of
invasion.
/.What is the classification of bladder cancer referred to in the guidelines? - Answer-
✅Urothelial carcinoma (UC), also described as bladder cancer.
/.What are the common occupational exposures that increase the risk of bladder
cancer? - Answer-✅Exposure to aromatic amines and ionising radiation.
/.What is the importance of complete resection of tumor tissue in bladder cancer? -
Answer-✅It should be achieved when possible for accurate diagnosis and staging.
/.What is the recommended follow-up for patients with a history of high-grade non-
muscle-invasive bladder cancer? - Answer-✅Regular monitoring and imaging to detect
any recurrence or progression.
/.What is the role of immune checkpoint inhibitors in bladder cancer treatment? -
Answer-✅They are part of the evolving treatment landscape for bladder cancer.
/.What is the significance of antibody drug conjugates in bladder cancer? - Answer-
✅They represent a novel therapeutic approach in the treatment of bladder cancer.
/.What is the primary goal of the ESMO Clinical Practice Guidelines for bladder cancer?
- Answer-✅To provide evidence-based recommendations for diagnosis, treatment, and
follow-up.
/.When were the ESMO Clinical Practice Guidelines for bladder cancer made available
online? - Answer-✅30 November 2021.
/.What is the role of transurethral resection of the bladder tumor (TURBT) in bladder
cancer? - Answer-✅It is used for obtaining tissue for histological evaluation.
,/.What is the relationship between bladder cancer and the presence of high-grade non-
muscle-invasive bladder cancer (NMIBC)? - Answer-✅Patients with a history of high-
grade NMIBC are at increased risk for recurrence and progression.
/.What is the primary symptom of bladder cancer experienced by 80% of patients? -
Answer-✅Painless haematuria.
/.What irritative symptoms may indicate invasive or high-grade tumors in bladder
cancer? - Answer-✅Dysuria, frequency, and urgency.
/.What types of pain might suggest bone metastasis or retroperitoneal metastases in
bladder cancer patients? - Answer-✅Bone pain or flank pain.
/.What are the key components of the work-up for suspected bladder cancer? - Answer-
✅History and physical examination, cystoscopic evaluation with biopsy or TURBT, urine
cytology, blood work, upper urinary tract imaging, and metastatic work-up.
/.What imaging technique is primarily used for upper urinary tract evaluation in bladder
cancer? - Answer-✅CT urogram.
/.What percentage of patients with bladder cancer present with non-muscle invasive
bladder cancer (NMIBC)? - Answer-✅Approximately 75%.
/.What are the classifications for muscle invasive bladder cancer (MIBC) according to
staging? - Answer-✅pT2a-pT4b.
/.What is the grading system for non-muscle invasive bladder cancer (NMIBC)
according to WHO 2016 criteria? - Answer-✅Graded as low grade (LG) or high grade
(HG).
/.What is the sensitivity of urine cytology in high-grade tumors including carcinoma in
situ (CIS)? - Answer-✅84%.
/.What is the sensitivity of urine cytology in low-grade tumors? - Answer-✅16%.
/.What is the role of TURBT in the staging of bladder cancer? - Answer-✅It allows for
staging up to T2.
/.What should be specified in the pathological report if small-cell/neuroendocrine
subtypes are present? - Answer-✅The percentage of these subtypes.
/.What oncogenic alteration is mentioned in the context of advanced bladder cancer? -
Answer-✅Fibroblast growth factor receptor (FGFR) DNA alterations.
, /.What type of therapy is being investigated for advanced bladder cancer? - Answer-
✅Immuno-oncology therapy biomarker testing.
/.What is the significance of programmed death-ligand 1 (PD-L1) expression in bladder
cancer? - Answer-✅It is used for patient selection in immuno-oncology therapy.
/.What is the WHO classification year referenced for pathological diagnosis in bladder
cancer? - Answer-✅2016
/.What is the recommended follow-up for clinicians regarding PD-L1 measurement? -
Answer-✅Follow European Medicines Agency (EMA) guidance.
/.What is the implication if squamous or adenocarcinoma components exceed 95% in a
tumor? - Answer-✅The tumor should be considered a pure squamous or
adenocarcinoma.
/.What is the primary method for histological diagnosis of bladder cancer? - Answer-
✅Cystoscopic evaluation and biopsy.
/.What is the purpose of the bimanual examination in bladder cancer diagnosis? -
Answer-✅To identify clinical T3 or T4 disease.
/.What is the publication date of the ESMO Guidelines referenced in the notes? -
Answer-✅November 2021.
/.What is the significance of Supplementary Tables S1, S2, and S3 mentioned in the
document? - Answer-✅They provide additional information related to the management
and classification of bladder cancer.
/.What are the characteristics of low-risk tumours in NMIBC? - Answer-✅Primary,
solitary, Ta G1 (PUNLMP, LG), <3 cm, no CIS.
/.What is the treatment recommendation for low-risk tumours after TURBT? - Answer-
✅One immediate instillation of intravesical chemotherapy followed by cystoscopic
surveillance.
/.How are intermediate-risk tumours defined in NMIBC? - Answer-✅All tumours not
defined in the low or high-risk categories.
/.What are the treatment options for intermediate-risk tumours? - Answer-✅Full-dose
BCG instillations for 1-3 years or radical cystectomy; immediate instillation of
intravesical chemotherapy for patients with low recurrence rates and expected EORTC
recurrence score <5.
