Genitourinary Cancer

Question 1

What are the types of renal cell carcinoma?

Answer 1

Clear Cell - vHL on Chr 3 - HIF unregulated

Papillary - Type 1 MET mutation

Question 2

What is the treatment for Renal Cell Ca?

Answer 2

1. TKI
   - Bevacizumab
   - Sunitinib (VEGF and PDGF)
   - Carbozanitinib (C-MET, VEGFR)
2. Immunotherapy
   - mTOR: tacrolimus
   - PD1/PDL1: nivolumab, ipilimumab

Question 3

What is castration resistant prostate Ca?

Answer 3

prostate cancer growth despite castrate levels of testosterone (<1.7)

Question 4

What are genetic risk factors for prostate ca?

Answer 4

BRCA1, BRCA 2, CHEK 2, ATM

Question 5

What is the treatment for organ confined disease prostate Ca?

Answer 5

radical prostectomy/prostate radiotherapy
ADJ ADT if High Risk
6 monthly PSA surveillance
no real role for ADJ RT post op, but can use as salvage if PSA pops up (but incontinence issue!)

Question 6

What is the management of Castrate sensitive Metastatic Prostate Ca?

Answer 6

ADT + Chemo
ADT
- GNRH Agonist (Goserelin, leuprolide) - continuous release instead of pulsatile
- GNRH antagonist (Degarelix) - directly downregulate FSH/LH (for CVD pts)
BONE MET: BICALUTAMIDE
- Testosterone blocking (Stop DHT bind to androgen receptor)
CHEMO
- Docetaxel (tubulin binder - inhibit mitosis)
- Abiraterone (block 17a hydroxylase, c17,20 lyase - no testosterone synthesis) - need STEROID COVER
- 17a hydroxylase blocking causes increase steroid and decrease aldosterone
- C17,20 lyase blocking causes increase cortisol
- Enzalutamide (inhibit testosterone binding to androgen receptor (NOT FOR SEIZURE PPL)

Question 7

What is the management of Castrate resistant Metastatic prostate ca?

Answer 7

1. Androgen - GNRH Agonist + Enzalutamide
2. Chemo - Carbazitaxel (after docetaxel)
3. PSMA labelled lutetium
4. Bone therapy - Denosumab/Zoledronic

Question 8

What is the treatment of non muscle invasive bladder ca?

Answer 8

TURBT + single dose intravesical chemo (Gemcitabine or mitomycin)
CONSIDER ADH immunotherapy if more invasive into lamina propria
- BCG (Attaches to tumour cells, activates Th1/CD8 T Cells)

Question 9

What is the treatment of muscle invasive bladder ca?

Answer 9

Cystectomy/Radical RT + NEOADJ/ADJ Chemo
Chemo
1. MVAC (Methotrexate + Vinblastine + Doxorubicin + Cisplatin)
2. Gemcitabine + Cisplatin
3. Nivolumab if PDL1 >1%

Question 10

What are the types of testicular ca?

Answer 10

1. seminoma
NORMAL AFP, HIGH BHCG, HIGH LDH
most common
2. non seminoma
HIGH AFP

Question 11

What is the management of Testicular ca according to stages?

Answer 11

Stage 1 (only testis)
- seminoma: orchidectomy + Carboplatin/RT
- non seminoma: orchidectomy + BEP (Bleomycin + Etoposide + Platinum) (NO RT)
Stage 2/3: BEP FOR BOTH

Question 12

What is the treatment of ovarian cancer according to staging?

Answer 12

High Grade Serous - RESECT + ADJ Chemo

• Chemo: Platinum doublet (Carboplatin + Paclitaxel) + Bevacizumab
• if bulky disease - think NEOADJ Chemo
• If BRCA - PARPi
• if progression after 6 month - can trial different platinum doublet

Other types: RESECT + Platinum Doublet

Question 13

What is the staging of Ovarian Ca?

Answer 13

FIGO Staging
1 limited to ovary
2 pelvic organs
3 peritoneal cavity
4 distant mets

Question 14

What are the risk factors for endometrial cancer?

Answer 14

OBESITY (!!), metabolic syndrome
Excess estrogen, nulliparity, menarche, late menopause, Tamoxifen, HRT
MSH6, Lynch MLH1, MSH2

Protective (OCP, increased Parity)

Question 15

What is the management of endometrial ca?

Answer 15

1. Hysterectomy + RT
2. ADJ Chemo (Platinum doublet)
3. Immunotherapy: pembrolizumab + Levantinib (IF MMR)

Question 16

What is the management of cervical ca?

Answer 16

Stage 1A/B: Radical hysterectomy
Locally Advanced: cisplatin + RT
Advanced Disease: Palliative RT + Chemo (platinum Doublet)
- maybe bevacizumab/pembrolizumab