GU cancers

Question 1

poor risk RCC definition?

Answer 1

labs: High LDH, high calcium, low hgb clinical: PFS 70 or less, 2 or met sites and metastatic dz within 1 yr of nephrectomy

Question 2

Treatment for poor risk RCC patient?

Answer 2

temsirolimus - survival compared to interferon

Question 3

Side effects for anti-vegf therapy?

Answer 3

Hypertension
Diarrhea/GI side effects
Hand-foot syndrome
Fatigue
Elevated LFTs

Question 4

Side effects of everolimus and temsirolimus

Answer 4

PNEUMONITIS - GGO 
Dyspnea
Mouth Sores
Hyperglycemia
Rash

Give steroids for pneumonitis

Question 5

Von Hippel Lindau

Answer 5

hemangioblastoma (retinal and CNS)
pheochromocytoma
pancreatic neuroendocrine

Question 6

Hereditary leiomyomasosis

Answer 6

Papillary RCC (Fumarate hydratase)
Cutaneous lesions
Uterine fibroids

Question 7

Birt-Hogg-Dube

Answer 7

FLCN gene
chromophobe RCC
Lung cysts
Cutaneous lesions

Question 8

Stage 1A or 1B seminoma treatment after removal?

Answer 8

follow vs single agent carboplatin x 2 cycle vs 20gy radiation

Question 9

Most common chromosomal abnoramlity in germ cell tumors?

Answer 9

isochromosome 12p

Question 10

chemo for good risk, intermediate and poor risk

Answer 10

good risk : BEP 3 or EP x 4

intermediate and poor risk is: VIPX4 or BEP x 4

Question 11

quick and dirty good, intermediate, and poor risk for seminoma

Answer 11

NO POOR RISK FOR SEMINOMA

Good is everything but non–pulmonary mets

Question 12

quick and dirty good, intermediate, and poor risk for nonseminoma

Answer 12

poor risk is primary mediastinal or nonpulm mets or post orchiechtomy markers AFP>10k, hCG >50k, LDH>10x

intermediate is
AFP 1-10k
hcg 5-50k
LDH 1.5-10x nml

Question 13

growing teratoma syndrome

Answer 13

should be suspected in metastatic NSGCT, increasing size of met after chemo and normalization of tumor markers despite enlarging tumors

Question 14

treatment stage II or III bladder cancer

Answer 14

neoadjuvant MVAC or gem/cis
followed by cystectomy

if kidney dysfunction, go straight to cystectomy

Question 15

metastatic bladder - gem/cis vs MVAC

Answer 15

GEM/CIS inferior PFS but SAME OS as MVAC

Question 16

abiraterone toxicity

Answer 16

mineralocorticoid excess - HTN, hypoK, fluid overload

prednisone can attenuate increase in ACTH
blocks CYP17 enzyme in prostate, adrenals, and testicles.

Question 17

starting LHRH

Answer 17

not in bone disease - can cause flare and cord compression or bladder outlet obstruction so start casodez first fir 7 days or start degarlix

Question 18

Be careful with prostate cancer questions!

Answer 18

Make sure not small cell variant then Initiate a GNRH agent and plan for cisplatin/etoposide chemotherapy.

Question 19

pain medication oral morphine equivalents

Answer 19

To be effective, breakthrough pain medication—the short-acting dose—should be 10% to 20% of the total daily dose of long-acting.

In this case, patient has a 100 ug/hr fentanyl patch, which is = 200 OME (oral morphine equivalents). That means the short-acting dose should be somewhere in the range of 20-40 OME per dose.
oxycodone 1 =1.5
dilaudid 1=4
morphine 1=1
fentanyl 1=2
A. Incorrect because oxycodone 10 mg = 15 OME.
B. Incorrect because morphine is only 15 mg.
C. Incorrect because dilaudid 4 mg = 16 OME.
D. Incorrect because oxycodone 5 mg = 7.5 OME.
E. Correct answer because morphine 30 mg is the only answer that is within the 10% to 20% dose of long-acting.

Question 20

active surveillance for prostate cancer schedule

Answer 20

While there is no agreed upon schedule for active surveillance, it is generally accepted that the approach should include a combination of PSA testing and biopsy.

Most would agree that no testing should be performed more frequently than every 6 months. In addition, digital rectal examination should not be used more often than yearly. It is important to delineate between active surveillance

Question 21

imaging in patients with early prostate cancer

Answer 21

low risk for metastasis. This includes Stage T1c/T2a prostate cancer and cancers with a PSA less than 10 and a Gleason score of less than or equal to six due to the low risk of metastatic disease and added risk of radiation.

Question 22

• Postchemotherapy in seminoma and gct

Answer 22

o Seminoma: CT, if >3cm mass then PET (at least 6 wks post chemo), if PET+ consider repeating a few weeks later or biopsy, if viable disease à RPLND or 2nd line chemo

o NSGCT: RPLND if residual mass >1cm, resected all other residual sites of disease (don’t biopsy, wont matter if necrotic)

• If viable GCT à 2 additional cycles of chemo.
• If teratoma à surveillance

Question 23

• Trimodality approach in select patients (urothelial histology,

Answer 23

complete TUR, cT2-cT3a, no hydro, no CIS, unifocal, tumor < 5cm, bladder worth sparing) with similar outcomes to RC and includes: max TUR, radiosensitizing chemo