GU cancers Flashcards
poor risk RCC definition?
labs: High LDH, high calcium, low hgb clinical: PFS 70 or less, 2 or met sites and metastatic dz within 1 yr of nephrectomy
Treatment for poor risk RCC patient?
temsirolimus - survival compared to interferon
Side effects for anti-vegf therapy?
Hypertension Diarrhea/GI side effects Hand-foot syndrome Fatigue Elevated LFTs
Side effects of everolimus and temsirolimus
PNEUMONITIS - GGO Dyspnea Mouth Sores Hyperglycemia Rash
Give steroids for pneumonitis
Von Hippel Lindau
hemangioblastoma (retinal and CNS)
pheochromocytoma
pancreatic neuroendocrine
Hereditary leiomyomasosis
Papillary RCC (Fumarate hydratase)
Cutaneous lesions
Uterine fibroids
Birt-Hogg-Dube
FLCN gene
chromophobe RCC
Lung cysts
Cutaneous lesions
Stage 1A or 1B seminoma treatment after removal?
follow vs single agent carboplatin x 2 cycle vs 20gy radiation
Most common chromosomal abnoramlity in germ cell tumors?
isochromosome 12p
chemo for good risk, intermediate and poor risk
good risk : BEP 3 or EP x 4
intermediate and poor risk is: VIPX4 or BEP x 4
quick and dirty good, intermediate, and poor risk for seminoma
NO POOR RISK FOR SEMINOMA
Good is everything but non–pulmonary mets
quick and dirty good, intermediate, and poor risk for nonseminoma
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
growing teratoma syndrome
should be suspected in metastatic NSGCT, increasing size of met after chemo and normalization of tumor markers despite enlarging tumors
treatment stage II or III bladder cancer
neoadjuvant MVAC or gem/cis
followed by cystectomy
if kidney dysfunction, go straight to cystectomy
metastatic bladder - gem/cis vs MVAC
GEM/CIS inferior PFS but SAME OS as MVAC
abiraterone toxicity
mineralocorticoid excess - HTN, hypoK, fluid overload
prednisone can attenuate increase in ACTH
blocks CYP17 enzyme in prostate, adrenals, and testicles.
starting LHRH
not in bone disease - can cause flare and cord compression or bladder outlet obstruction so start casodez first fir 7 days or start degarlix
Be careful with prostate cancer questions!
Make sure not small cell variant then Initiate a GNRH agent and plan for cisplatin/etoposide chemotherapy.
pain medication oral morphine equivalents
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.
active surveillance for prostate cancer schedule
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
imaging in patients with early prostate cancer
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.
- Postchemotherapy in seminoma and gct
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
- Trimodality approach in select patients (urothelial histology,
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
