Miriam (78 years old)

Miriam, a 78-year-old opera singer, has sung in theatres all over the world. Now she enjoys a simple life in a small cottage surrounded by vineyards.

She underwent a TURBT of a 4 cm papillary tumour at the right bladder wall, which was detected during a CT scan of the abdomen/pelvis for an ileal tumour.

Assessment summary:

• Passive smoker until the age of 38
• Medical history:
  • Gastric ulcers, hypertension, glaucoma
  • Left breast cancer 6 years ago: treated with surgery + radiotherapy
  • Recent ileal neuroendocrine tumour pT4 pN2 M1: treated with surgery
• Macroscopic haematuria a few days before the first urological consultation
• ECOG PS: 2
• Creatinine level: 42 µmol/l
• Maximal debulking TURBT:
  • Incomplete resection at depth
  • High-grade UCa infiltrating up to the muscularis
  • Minimal pT2
• CT scan of thorax/abdomen/pelvis: no distant lesions or synchronous UTUC
• TMT:
  • No residual tumour on second TURBT
  • Intensity modulated RT on the entire bladder (55 Gy in 20 fractions)
  • Chemotherapy with fluorouracil and mitomycin C