Non-Muscle-Invasive Bladder Cancer: Review of Diagnosis and Management

Neil Pugashetti,¹ Shabbir M.H. Alibhai,³ Stanley A. Yap,^1,2

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Abstract: Non-muscle-invasive bladder cancer (NMIBC) represents the large majority of newly diagnosed bladder tumors and represents a significant burden to both patients and the healthcare system. Although the initial standard treatment for all non-muscle-invasive tumors is surgical resection, there exist a wide variety of both surgical and medical treatment modalities based upon the tumor's specific stage and grade. Ensuring a proper diagnosis is key, and management should be tailored to the individual in order to reduce cancer recurrence and prevent progression of disease.

Key Words: Bladder cancer, non-muscle-invasive, diagnosis, treatment.

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Non-muscle-invasive bladder cancer consists of papillary tumors (Ta), tumors invading the submucosal lamina propria (T1), and flat lesions known as carcinoma in situ (CIS).

Proper management is key given the significant risk of tumor recurrence or progression to muscle-invasive disease.

Many treatment modalities exist including transurethral resection, intravesical chemotherapy, intravesical immunotherapy, and radical cystectomy; treatment choice depends on a variety of factors including tumor stage and grade.

The gold standard for the complete work-up of hematuria is office cystoscopy and imaging of the upper urinary tract.

Initial standard treatment of non-muscle-invasive bladder tumors is TURBT; at the time of resection, sampling of muscle surrounding the lesion is important to accurately assess depth of invasion.

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Cutaneous Malignant Melanoma: Screening and Diagnosis

Fatemeh Akbarian, MD,¹ Mehdi Aarabi, MD,² Ali Vahidirad, MD,³ Mehrdad Ghobadi, MD,⁴ Mohaddeseh Ghelichli MD,⁵
Mohammad A. Shafiee, MD, MSc, FRCPC,^6
1Dermatologist, Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. ²Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. ^3,4,5Joint, Bone, Connective Tissue Research Center, Golestan University of Medical Sciences, Iran. ⁶Division of General Internal Medicine, Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.

Abstract
Cutaneous Malignant Melanoma has the highest morbidity and mortality among different types of skin cancers; as one of the most common malignancies in the world. Early detection and diagnosis of Cutaneous Malignant Melanoma followed by adequate surgical excision are the most important tasks in management of this potentially curable skin cancer. Screening methods and diagnostic criteria including clinical and dermoscopic findings will be discussed in this article.
Keywords: Melanoma, Dermoscopy, UV Exposure, Epiluminescence Microscopy (ELM).

A Rare Case of Pilomatrixoma in a Seventy-Six Year Old Lady

P.K. Shenoy, MD, DLO, FRCS, FACS¹, W. Wang, MD^2
1ENT Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada.
²Pathology Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada.

Abstract
Objectives: We report a rare case of Pilomatrixoma with an unusual presentation in an elderly individual.
Method: Case reports and review of the literature of Pilomatrixoma and its clinical presentation, familial ocuurence and genetic mutation are presented.
Result: Pilomatrixoma is a rare, slow growing benign skin tumour derived from the hair matrix cell that typically occurs in the head and neck.^8,9 Most cases of Pilomatrixoma occur in children under the age of 10. Rarely can it present in young adults or the middle age group where there is a female predominance.^1,2,12
Keywords: pilomatrixoma, calcifying epithelioma of Malherbe, haemorrhagic purplish nodule, solid and cystic, pleuropotential precursor, mutation, basophilic cells, shadow cells, CTNNB1.

An Unusual Case of Large B-cell Lymphoma of the Sinonasal Tract in a Ninety Year Old Woman

P.K. Shenoy, MD, DLO, FRCS, FACS¹, W. Wang, MD^2
1ENT Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada. ²Pathology Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada.

Abstract
Lymphoma accounts for 3 to 5% of malignant tumours, non-Hodgkin's lymphoma (NHL) accounts for 60% of all lymphoma. NHL of the sinonasal tract is an uncommon neoplasm that can be morphologically difficult to distinguish from non-neoplastic destructive lesions or malignant neoplasm. Only Immuno histochemistry could give a definite diagnosis. These represent 1.5 to 15% of NHL in the United States,¹ 2.6 to 6.7% of all lymphoma in Asia.² B cell phenotype are most frequently found in the Western Hemisphere while T cell lymphomas are found in Asian countries. B-cell lymphoma of sinonasal tract occur in 6th to 8th decade of life and have a better prognosis.³ Review of the literature shows that early diagnosis and prompt treatment with local radiation (XRT) or combined modality treatment (CMT) have shown good prognosis.⁴
Keywords: non-Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), disease free survival (DFS), overall survival (OS), epistaxis, rapid rhino® (Arthrocare ENT products).

A Practical Review of the Diagnosis and Management of Small Renal Masses

Stanley A. Yap,¹ Shabbir M.H. Alibhai,^2,3Antonio Finelli,^1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. ²Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. ³Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.

An Update on Cancer Screening in Older Adults

Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, University Health Network, Toronto, ON, Canada, Assistant Professor, Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, Research Scientist, Canadian Cancer Society

Abstract
More than one-half of new cancers and over 70% of cancer deaths occur in adults age 65 or older. Systematic screening has been associated with reductions in cancer- related mortality for a variety of cancers, including breast, cervical, and colorectal cancer. Prostate cancer screening remains more controversial despite the recent publication of two large randomized trials of screening. Although guidelines are beginning to address cancer screening specifically among the growing group of seniors age 70 or older, there is virtually no guidance on estimating remaining life expectancy or considering competing causes of mortality (e.g. comorbid medical illness) in this age group. In this article, I review evidence-based guidelines for cancer screening in adults and discuss the limitations of screening studies with respect to older adults. I have also highlighted new evidence and substantive updates to guidelines since the last publication on cancer screening in Geriatrics & Aging five years ago.

Keywords: cancer screening, aged, mass screening.