Male 77yo with a known bladder cancer for cystoscopy and diathermy.

Background:

• HTN
• COPD 48% FEV1
• Smoker – 120PYH
• Post-polio syndrome with chronic pain
• Chronic lower back pain
• Opioid tolerant ++ (160mg BD MS Contin, 10mg QID endone)

Issues:

• Incidental finding of LUL lesion (SCC ON BX)
  • T3N0M0
  • May be a candidate for curative surgery

Discussion:

• Should surgery proceed?
  • Similar level of morbidity to many of our urological patients
  • Minimally invasive procedure
  • Potential for significant morbidity prevention; diathermy of a small bladder cancer recurrence now will prevent large tumour (requiring larger procedure) or anaemia from bleeding at a later date
  • Low analgesia requirements so patient’s existing opioid tolerance not a huge concern

• Opportunities for optimisation looking towards possible thoracic surgery
  • Smoking cessation
  • Opioid reduction

Plan:

• Proceed with urology procedure
• Contact GP/patient about optimisation opportunities