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Oncology > GU > Flashcards

GU Flashcards

0
Q

What are the risk factors for germ cell tumors?

A

Abdominal and inguinal cryptorchidism, spermatic or testicular dysgenesis, and family history. Klinefelter syndrome is a risk factor for mediastinal germ cell tumors.

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1
Q

Are mixed germ cell tumors treated as seminoma or nonseminoma?

A

Nonseminoma

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2
Q

T or F: If testicular ultrasound is abnormal, biopsy should be performed.

A

False. A radical inguinal orchiectomy should be performed. A biopsy is contraindicated because the normal vascular and lymphatic drainage would be disturbed.

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3
Q

What are the nonseminoma histologies?

A

Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac or endodermal-sinus tumors.

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4
Q

Does an abnormal serum AFP level indicate a seminoma or nonseminoma?

A

Always nonseminoma.

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5
Q

What are the adverse factors of germ cell tumors?

A

Mediastinal primary site; degree of elevation of AFP, HCG, LDH; nonpulmonary visceral mets

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6
Q

What is the treatment for stage I seminoma?

A

Radical inguinal orchiectomy. Afterwards, options include: surveillance, radiation to the para-aortic nodes, or a single dose of carboplatin. XRT is contraindicated if IBD or horseshoe kidney.

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7
Q

Treatment for stage IIA seminoma?

A

Radiation.

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8
Q

Treatment for stage IIB seminoma?

A

Chemotherapy or radiation.

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9
Q

Treatment for advanced seminoma?

A

Chemotherapy. After 6 weeks, get PET CT. If pos, consider surgery.

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10
Q

Adjuvant treatment for stage I nonseminoma?

A

Stage IA: close surveillance. High-risk IB (embryonal predominant, lymphatic, vascular, scrotal, spermatic cord invasion): nerve sparing RPLND.

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11
Q

Adjuvant treatment for stage II nonseminoma?

A

First, RPLND. Then, if N1 (pos node 2 cm or > 5 involved nodes or extranodal extension) chemo for 2 cycles. If N3 (node > 5 cm), chemo for 3 or 4 cycles. If serum markers do not normalize, surgery.

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12
Q

Treatment for advanced germ cell tumor?

A

Good risk: cis/etop x 4 or BEP x 3. Intermediate risk: BEP x 4. Poor risk: BEP x 4.

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13
Q

Salvage therapy for germ cell tumors?

A

Vinblastine/ifos/cis, TIP (paclitaxel, ifos, cis), cis/epirubicin. If these fail, consider high-dose chemo with peripheral stem cell rescue.

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14
Q

After chemo for germ cell tumors, if we have residual radiographic abnormalities but normal serum tumor markers, what should we do next?

A

Surgery.

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15
Q

Which cancers can a teratomatous component of a nonseminoma transform into?

A

Rhabdomyosarcoma, adenocarcinoma, primitive neuroectoderm tumor, and leukemia.

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16
Q

T or F: bladder cancer is more common in men than women, whites than blacks.

A

T

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17
Q

Risk factors for bladder cancer?

A

Smoking, occupational exposures, urinary tract diseases, drugs.

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18
Q

T staging for bladder?

A

Ta: noninvasive papillary lesions.
Tis: carcinoma in situ
T1: invades the subepithelial connective tissue
T2: invades muscle
T3: invades perivesical tissue
T4: invades prostate, uterus, vagina, pelvic, abdominal wall

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19
Q

Treatment for non-muscle-invasive bladder cancer?

A

Transurethral resection. Intravesical BCG x 6 weekly doses for T1, Tis, and recurrent or multifocal Ta. Other agents: mitomycin C, gem, doxorubicin, valrubicin.

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20
Q

Treatment for muscle-invasive bladder cancer?

A

Neoadjuvant with cis/gem for certain patients, then radical cystectomy with bilateral pelvic lymphadenectomy. No definitive data on adjuvant chemo. A bladder preservation approach using transurethral resection, radiation, chemo can be considered.

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21
Q

Treatment for metastatic bladder cancer?

A

MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and cis/gem. Both regimens are similarly efficacious.

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22
Q

Risk factors for RCC?

A

Smoking, obesity, hypertension, acquired cystic kidney disease

23
Q

Treatment for localized RCC?

A

Nephrectomy. No benefit to adjuvant radiation.

24
Q

What is Stauffer syndrome?

A

Signs and symptoms of hepatic dysfunction in patients with localized RCC.

25
Q

Is there a role for cytoreductive nephrectomy in metastatic RCC?

A

Yes. Combined with system therapy, it can prolong OS.

26
Q

Histologies of RCC?

A

Clear cell, papillary (more favorable than clear cell), chromophobe (indolent), and collecting duct (very aggressive).

27
Q

What is Von Hippel-Lindau disease?

A

RCC, retinal angiomas, hemangioblastomas of the spinal cord and cerebellum, pheochromocytomas. VHL promotes the ubiquitination and destruction of HIF-alpha.

28
Q

Systemic therapies for metastatic RCC?

A

Bev > placebo. Bev + IFN > IFN alone. Sunitinib > IFN. Pazopanib > placebo. Pazopanib ~ sunitinib (pazo has better QOL). Sorafenib > placebo. Sorafenib ~ IFN. Temsirolimus > IFN. Everolimus > placebo. Can also consider IFN and IL-2.

29
Q

How many men will develop prostate cancer in the United States?

A

One in six

30
Q

Results of the Prostate Cancer Prevention Trial (with finasteride)?

A

Reduction in incidence of prostate cancer but more high-grade cancer. No long term difference in OS.

31
Q

Bone scans are recommended in prostate cancer if one of the following is true:

A

T1-2 and PSA > 20; Gleason 8; T3-4; or symptoms of bone mets

32
Q

Treatment options for localized prostate cancer?

A

Low risk: active surveillance, brachytherapy, external beam radiation, radical prostatectomy. High risk: combined modality such as external beam radiation with ADT for 3 years.

33
Q

Strong data to support neoadjuvant or adjuvant ADT with surgery for localized prostate cancer?

A

No

34
Q

Role of neoadjuvant or adjuvant ADT with external beam radiation for localized prostate cancer?

A

Beneficial. High risk disease: long term ADT for at least 2 years.

35
Q

Which group of patients with localized prostate cancer can have active surveillance?

A

Good risk: Gleason

36
Q

What are the main side effects of medical or surgical castration?

A

Gynecomastia, impotence, loss of libido, weakness, fatigue, hot flashes, loss of muscle mass, changes in personality, anemia, depression, and loss of bone.

37
Q

Does denosumab increase bone mass in men receiving ADT for nonmetatastic prostate cancer?

A

Yes.

38
Q

For metastatic prostate cancer, is combined therapy of GnRH agonist/antagonist and antiandrogen better than monotherapy?

A

Modest improvement. Antiandrogen monotherapy is inferior to testosterone-lowering therapy.

39
Q

For androgen-sensitive, metastatic prostate cancer, is early ADT better than delayed?

A

Yes.

40
Q

Continuous versus intermittent ADT for metastatic prostate cancer?

A

Sand OS and PFS. Better toxicity with intermittent.

41
Q

Results of ADT vs ADT plus docetaxel for metastatic non-castrate prostate cancer?

A

Better OS for chemohormonal, especially for high volume disease

42
Q

Efficacy of sipuleucel-T?

A

Better OS than placebo: 25.8 months vs 21.7. But same time to progression.

43
Q

Chemo for metastatic CRPC?

A

Docetaxel> mitoxantrone. After progression on docetaxel, cabazitaxel > mitoxantrone.

44
Q

Efficacy of abiraterone in CRPC?

A

Better than placebo both before and after chemo

45
Q

Data on enzalutamide on CRPC?

A

Better than placebo both before and after chemo

46
Q

Cabozantinib in CRPC?

A

Pain relief, clinical, soft tissue and bone scan responses.

47
Q

Radium-223 in CRPC?

A

Better OS compared to placebo in men with symptomatic bone mets.

48
Q

Treatment for bone mets in CRPC?

A

Denosumab, zoledronate

49
Q

How to treat malignant adrenal cortical carcinoma?

A

Surgery for localized disease. Otherwise, mitotane.

50
Q

How many patients receiving trimodality bladder preservation therapy will still need cystectomy?

A

One third

51
Q

Which treatment for CRPC is associated with a survival benefit: strontium-89, samarium-153, radium-223, denosumab, zolendronic acid?

A

Radium-223

52
Q

Testicular mass in a man older than 50. Most likely diagnosis?

A

Lymphoma

53
Q

What is the most commonly mutated gene in clear cell RCC?

A

VHL

54
Q

What should patients on pazopanib have monitored closely?

A

LFTs

Oncology (12 decks)

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