Urotheelcelcarcinoom - Med-Info

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Inhoudsopgave Algemeen.......................................................................................................................................................1 Risicofactoren...............................................................................................................................................4 Diagnostiek....................................................................................................................................................6 Symptomen........................................................................................................................................6 Lichamelijk onderzoek........................................................................................................................6 Urine cytologie....................................................................................................................................6 Urine testen........................................................................................................................................7 Beeldvormend onderzoek..................................................................................................................7 Urethro-Cytoscopie..........................................................................................................................10 Transurethale resectie van blaastumoren (TURT)...........................................................................10 Blaasbiopten.....................................................................................................................................11 Fluorescentie cytoscopie..................................................................................................................12 Pathologie........................................................................................................................................13 Tumorclassificatie......................................................................................................................13 Stadiëring...................................................................................................................................16 Inzenden van materiaal..............................................................................................................17 Verwerking van materiaal..........................................................................................................17 Rapportage................................................................................................................................18 Re-TURT..........................................................................................................................................19 Verpleegkundige en ondersteunende zorg, voorlichting en communicatie......................................20 Behandeling.................................................................................................................................................22 TaT1.................................................................................................................................................22 Voorspellen recidief en progressie.............................................................................................22 Behandeling na TURT...............................................................................................................23 CIS...................................................................................................................................................27 Behandeling...............................................................................................................................28 BCG toxiciteit.............................................................................................................................32 Behandelopties na falen BCG....................................................................................................33 T2+...................................................................................................................................................34 Curatieve behandeling...............................................................................................................34 Neoadjuvante radiotherapie.......................................................................................................38 Neoadjuvante chemotherapie....................................................................................................40 Adjuvante chemotherapie..........................................................................................................42 Urine derivatie na cystectomie...................................................................................................42 Lymfeklierdissectie...........................................................................................................................44 Hoe uitgebreid?..........................................................................................................................44 Overlevingsvoordeel..................................................................................................................46 Prognostische waarde...............................................................................................................48 Nacontrole en nazorg..................................................................................................................................50 Frequentie nacontrole......................................................................................................................50 Verpleegkundige en ondersteunende zorg, voorlichting en communicatieFreq...............................53 Behandeling metastasen op afstand.........................................................................................................58 Palliatieve zorg............................................................................................................................................60 Implementatie..............................................................................................................................................61 TNM classificatie.........................................................................................................................................62 Referenties...................................................................................................................................................63 Bijlagen........................................................................................................................................................90 Resultaten........................................................................................................................................96 i
Inhoudsopgave CT = computer tomografie; MRI = magnetic resonance imaging; PPV = positive predictive value = positief voorspellende waarde; NPV = negative predictive value = negatief voorspellende waarde.........................................................................................................................................................97 Resultaat..........................................................................................................................................97 Opmerkingen, commentaar.......................................................................................................97 Independent progostic factor:..................................................................................................100 Resultaat..................................................................................................................................102 Opmerkingen, commentaar.....................................................................................................102 Resultaat..................................................................................................................................102 Opmerkingen, commentaar.....................................................................................................102 Uitgangsvraag 3: Effect van toepassen van intravesicaal chemotherapie of BCG al of niet in onderhoudsbehandeling op recidieffrequentie van niet-spierinvasief blaascarcinoom...................104 Resultaat........................................................................................................................................104 Opmerkingen, commentaar.....................................................................................................104 Uitgangsvraag 3: Effect van intravesicaal chemotherapie versus BCG of KLH, op de progressiekans van niet-spierinvasieve blaastumoren naar spierinvasie.........................................105 Resultaat........................................................................................................................................105 Opmerkingen, commentaar.....................................................................................................105 Resultaat..................................................................................................................................105 Opmerkingen, commentaar.....................................................................................................105 CR=complete response rate, OS = overall survival, LC = lokale controle...........................................107 Resultaat........................................................................................................................................107 Opmerkin-gen, commentaar....................................................................................................107 Uitgangsvraag 4:Brachytherapie.............................................................................................................108 Resultaat........................................................................................................................................108 Opmerkingen, commentaar.....................................................................................................108 OS = 5 jaar overall survival, LC = 5 jaar lokale controle, DSS = 5 jaar disease specific survival, NS = not significant..................................................................................................................................109 Resultaat........................................................................................................................................109 Opmerkingen, commentaar.....................................................................................................109 Resultaat..................................................................................................................................109 Opmerkingen, commentaar.....................................................................................................109 Resultaat..................................................................................................................................110 Opmerkingen, commentaar.....................................................................................................110 Resultaat..................................................................................................................................111 Opmerkingen, commentaar.....................................................................................................111 Resultaat..................................................................................................................................111 Opmerkingen, commentaar.....................................................................................................111 Resultaat..................................................................................................................................112 Opmerkingen, commentaar.....................................................................................................112 Resultaat..................................................................................................................................113 Opmerkingen, commentaar.....................................................................................................113 Resultaat..................................................................................................................................114 Opmerkingen, commentaar.....................................................................................................114 Resultaat..................................................................................................................................115 Opmerkingen, commentaar.....................................................................................................115 Resultaat..................................................................................................................................115 Opmerkingen, commentaar.....................................................................................................115 Resultaat..................................................................................................................................116 Opmerkingen, commentaar.....................................................................................................116 Resultaat..................................................................................................................................117 Opmerkingen, commentaar.....................................................................................................117 Resultaat..................................................................................................................................117 Opmerkingen, commentaar.....................................................................................................117 ii
Page 1: Urotheelcarcinoom van de blaas Land
Page 5 and 6: Algemeen Literatuurbespreking: Aanl
Page 7 and 8: laascarcinoom ten aanzien van initi
Page 9 and 10: Richtlijn: Urotheelcarcinoom van de
Page 11 and 12: uitslagen komen bijna niet voor. Ni
Page 15 and 16: moet de blaas niet meer dan tot ong
Page 17 and 18: Fluorescentie cystoscopie heeft een
Page 21 and 22: invasie in mm met behulp van een oc
Page 23 and 24: is in de prostaat is het van belang
Page 27 and 28: Beperking van deze metaanalyse is d
Page 29 and 30: van 2,5 jaar bij 4863 patiënten wa
Page 31 and 32: laassparende behandelingsoptie. CIS
Page 33 and 34: Gerandomiseerde studies met verschi
Page 35 and 36: Overeenkomsten tussen de uitingsvor
Page 37 and 38: ehandeling. Niveau 2: A2 van der Me
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slechtere 5-jaars ziektevrije overl
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Richtlijn: Urotheelcarcinoom van de
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Implementatie Literatuurbespreking:
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Referenties 1 - Abdel-Latif M Abdel
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Bostwick DG, Eble JE. Urologic Surg
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56 - Daimoiseaux V Daimoiseaux V, V
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495-9. 83 - Friedrich MG Friedrich
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node dissection and radical cystect
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166 - Lamm DL Lamm DL, Blumenstein
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long-term results. J Urol 2000; 163
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• Mw. H.W.G. Hamelers-Paulus, sec
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• Regionale IKC tumorwerkgroepen
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5. Wat is de plaats van neo-adjuvan
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CT = computer tomografie; MRI = mag
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Holmang 2005-274 Jimenez 2000-980 L
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Vardar 2006-27 Whisnant 2003-186 Yi
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Uitgangsvraag 3: Effect van intrave
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CR=complete response rate, OS = ove
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OS = 5 jaar overall survival, LC =
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Sanchez-Ortis 2003 Lee 2006 Auteurs
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Malmstrom (1996) Nordic 164 Sherif
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Stein 2006a Stein 2006b Skinner 198
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Auteurs, jaartal Mate van bewijs St
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Herr 2003 Stein 2001 Vieweg 1999 Au
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Herr 2007 Herr 2003B Stein 2003 Aut
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Uitgangsvraag 8 Evidence tabel foll
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jaartal van bewijs Gidlow 2000 Fait
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Verpleegkundige aspecten: Het verdi
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12. Juridische betekenis Juridische
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16. Onafhankelijkheid werkgroeplede
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Di Stasi 2003 BCG versus Adriamycin
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Notities Indeling van de onderbouwi
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