⚠ DIAGNOSTIC PHASE — TREATMENT PLAN NOT YET APPLICABLEDIAGNOSTIC PHASE — TREATMENT PLAN NOT YET APPLICABLE. Histology required before any therapy discussion (CHARTER §15.2 C7).
Patient
PZ-DIAG-URO-001 · suspicion lineage: urothelial_carcinoma
Tissues: bladder, right_lateral_wall · Hypotheses: DIS-UROTHELIAL
68M heavy smoker (45 pack-years, current) presents to urology with 3 episodes of gross_painless_hematuria over 6 weeks (visible blood in urine, no clots, no dysuria, no flank pain). PCP UA showed 50+ RBC/hpf, no infection. Urine cytology atypical urothelial cells, suspicious for malignancy. CT urogram: 2.8 cm right_lateral_wall_bladder_mass with no obvious wall invasion on CT (need TURBT for muscle invasion assessment). No upper tract lesions. No regional LAD. Cystoscopy in clinic confirmed papillary mass with sessile component. Patient counseled for TURBT + bimanual EUA to assess for cT2+ disease. No prior bladder cancer, no occupational chemical exposure.
Matched workup: WORKUP-SUSPECTED-UROTHELIAL · Очікуваний термін: ~ дnoв
Workup steps (7)
- 1histology Cystoscopy with biopsy / TURBT
Direct visualization of bladder mucosa, biopsy of suspicious lesions, and transurethral resection of bladder tumor (TURBT) for diagnosis, staging (muscle-invasive vs non-muscle-invasive), and initial management.
- 2lab Voided urine cytology (Paris System)
Adjunct to cystoscopy for hematuria workup; sensitive for high-grade urothelial carcinoma and CIS, low sensitivity for low-grade tumors.
- 3imaging CT urography (multi-phase with excretory phase)
Evaluation of upper urinary tract for hematuria workup; detects upper-tract urothelial carcinoma (UTUC), renal masses, and parenchymal pathology. Excretory phase essential for urothelial evaluation.
- 4lab Complete Blood Count with Differential
Baseline cytopenia assessment and ongoing monitoring of myelosuppression.
- 5lab Comprehensive Metabolic Panel
Електроліти (Na, K, Cl, HCO3), креатиnoн + BUN (renal function), глюкоза, кальцій, альбумін, total protein. Базова метаболічна оцінка перед будь-якою терапією + основа TLS risk + dosing adjustments.
- 6lab Liver Function Tests
Assess hepatic function — baseline + during BR cycles + DAA therapy + HBV reactivation monitoring.
- 7lab Renal function panel with eGFR (creatinine, BUN, electrolytes)
Baseline renal function before iodinated contrast, nephrotoxic systemic therapy, partial vs radical nephrectomy planning, and HRR / cisplatin eligibility.
MDT brief
MDT talk tree (3 steps)
| # | Owner | Topic | Action |
|---|
| 1 | pathologist | Specialist review | Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests. |
| 2 | radiologist | Specialist review | Stage / restaging imaging + biopsy guidance — radiologist. |
| 3 | surgical_oncologist | Specialist review | Suspected solid tumor — resectability assessment, biopsy approach. |
Skills (required) — mandatory virtual specialists (2)
- Pathologist (general) required
Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests.
- Radiologist required
Stage / restaging imaging + biopsy guidance — radiologist.
Skills (recommended) — for consideration (1)
Technical MDT skill metadata (3/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |