The Expanding Treatment Paradigm for Urothelial Carcinoma - Episode 1

Overview on Urothelial Carcinoma: Risk Factors, Symptoms, and Staging

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Opening their discussion on urothelial carcinoma management, panelists highlight risk factors, symptoms, and staging practices in this setting.

Transcript:

Petros Grivas, MD, PhD: Hello, and welcome to this Cancer Network® presentation, The Expanded Treatment Paradigm for Urothelial Carcinoma. I’m your host today, Dr. Petros Grivas. I’m a medical oncologist at the University of Washington and the Fred Hutchinson Cancer Center in Seattle. I’m very excited today to be here at ESMO Congress 2022 and to be surrounded by really amazing contributors in the genitourinary [GU] cancers field, people who have really changed the world, I would say, in the field of GU cancers. I will start on my right, Dr. Guru Sonpavde. Guru, do you want to introduce yourself?

Guru P. Sonpavde, MD: Thank you, Petros. I’m Dr. Guru Sonpavde. I’m the GU oncology director at the Advent Health Cancer Institute in Orlando, Florida.

Petros Grivas, MD, PhD: Welcome, Guru. And Dr. Srikala Sridhar from Toronto.

Srikala Sridhar, MD, MSc, FRCPC: Thank you, Petros. My name is Srikala Sridhar. I’m a professor at the University of Toronto and a medical oncologist at the Princess Margaret Cancer Centre in Toronto.

Petros Grivas, MD, PhD: Welcome, Srikala, great to have you. And Dr. Cora Sternberg.

Cora Sternberg, MD, FACP: It’s wonderful to be here. My name is Cora Sternberg and I’m a professor at Weill Cornell Medicine and the clinical director at the Englander Institute for Precision Medicine in New York.

Petros Grivas, MD, PhD: Welcome, Cora. And Tian Zhang.

Tian Zhang, MD, MHS: Thanks, Petros. I’m Tian Zhang, I’m a GU medical oncologist at the University of Texas Southwestern Medical Center in Dallas.

Petros Grivas, MD, PhD: Thanks for being here. Welcome, everybody. And it’s very exciting to be in person at ESMO 2022 and to see each other and exchange ideas. Today we’re going to discuss clinical scenarios, review recent data, and discuss how the care in the landscape is rapidly evolving in the field of urothelial cancer. We’re going to discuss, as we go forward, specific cases, but I want to start with the broad picture, Srikala, with you. If you can give us a sense about the epidemiology—incidents, risk factors for urothelial carcinoma, and how do we stage and diagnose this disease?

Srikala Sridhar, MD, MSc, FRCPC: Bladder cancer is about the 10th most common cancer overall in the world, and it’s about the sixth most common in men. So, about a 3 to 1 ratio of men to women. Overall annually, there are about 570,000 new cases. So it’s a really important cancer that we need to see some new advances happening soon. The main risk factors, as you know well, are smoking; working in some of the industries can do it, and for some people upper tract disease, there’s a risk factor of some of the herbal products, and prior pelvic radiation. So these are some of the things that we think about. In terms of presentation, hematuria is a common presentation. So if patients see blood in their urine, they should see their family doctor. Other symptoms are more nonspecific: weight loss, decreased appetite, or sometimes pain, difficulty breathing, depending on where this cancer may go. In terms of diagnosis, the most common way this is diagnosed, often to start they have a urinalysis, looking for blood in the urine, followed by a cystoscopy. And then often we’ll have a CT scan to assess for whether the disease has spread to other places in the body.

Petros Grivas, MD, PhD: Absolutely. And to your point, Srikala, there have been delays in the diagnosis of bladder cancer, especially in women.

Srikala Sridhar, MD, MSc, FRCPC: Absolutely.

Petros Grivas, MD, PhD: This is attributed to UTIs [urinary tract infections]. A great message for primary care providers is to not ignore hematuria send for an early work-up.

Srikala Sridhar, MD, MSc, FRCPC: For sure. And then the other thing, this is a disease that tends to affect older people. The average age is about 72, so many patients will have comorbidities. But it’s also important to keep in mind that this can affect younger people. So if they have symptoms that are concerning, they need to be evaluated.

Petros Grivas, MD, PhD: Absolutely. And we have some challenge with staging bladder cancer, and CT scans are good, but not perfect. Any comments on that?

Srikala Sridhar, MD, MSc, FRCPC: Absolutely. There’s an understaging rate of about 30%. So what you see is not always what you get. Newer staging techniques are being evaluated, MRI and PET [positron emission tomography] scans, they may help us to have a better understanding of the disease at baseline.

Petros Grivas, MD, PhD: Absolutely. And we’re encouraging clinical studies looking at those novel imaging techniques, MRIs, PET scans, and clinical studies.

Transcript edited for clarity.