Roundtable Roundup: Bladder Cancer

CASE SUMMARY

A man aged 74 years presents to his primary care physician reporting intermittent episodes of painless macrohematuria.

History

• Stage 3a chronic kidney disease; type 2 diabetes
• New York Heart Association heart failure grade 2
• Medications: empagliflozin once daily; enalapril once daily
• Mild chronic obstructive pulmonary disease
• Tobacco history: current smoker, 20 pack-years
• Retired textile chemist

Focused Physical Exam

• ECOG performance status: 1
• Pulmonary: diminished lung sounds, inspiratory rhonchi, expiratory wheezing on auscultation

Evaluation by Urologic Oncologist

• History of renal insufficiency: cisplatin-ineligible
• Arterial portography MRI and magnetic resonance urography:
  • Nodular, 6-cm lesion within the left, posterior bladder wall invasive into inner half of muscularis propria
  • No renal parenchymal masses
  • Enlarged single, regional, obturator node, measuring 8 mm
  • No evidence of lymph node involvement or hepatic metastasis
• Chest CT without metastasis
• White light cystoscopy and barbotage detected single, penetrating lesion along right lateral bladder wall
  • Bladder wash samples and multiple tissue specimens obtained
• Cytohistopathology: N:C ratio > 0.7; nuclear pleomorphism; moderate to severe hyperchromasia
• High-grade urothelial carcinoma

_REFERENCE

_{1. Galsky MD, Witjes JA, Gschwend JE, et al. Adjuvant nivolumab in high-risk muscle-invasive urothelial carcinoma: expanded efficacy from CheckMate 274. J Clin Oncol. 2025;43(1):15-21. doi:10.1200/JCO.24.00340}