GU tumours Flashcards
what are the features of good prognosis of seminomas?
any primary site
no non-pulm visc mets
markers:
normal aFP
any bhCG
any LDH
what are features of good prognosis of non-seminomatous test CA?
test or retroperitoneal primary
no non0pulm mets
afp <1.5 ULN
what are the treatments of stage 1 non-seminoma?
while this is a good prognosis condition, relapse is around 25%
if there are compliance concerns then we use BEP for 2 cycles
what is the chemo treatment for metastatic renal cancer?
sunitinib and pazopanib are both multi target oral TKi
what are some of the side effects of the TKIs?
fatigue
hand-foot syndrome
hypertension
BM suprression
some LFT derangement
what do flutamide and bicalutamide do?
both of these are androgen receptor antagonists working particularly at the prostate itself
what are the new treatments for prostate cancer?
castrate refractory prostate cancer now has a pre-docetaxel and post-docetaxel scenario
there are 4 drugs with survival benefit post-docetaxel
cabazitaxel (this is a taxane)
abiraterone - this is an adrenal gland synthesis blocker (blocks CYP17) - given with pred due to hypoadrenalism. Can get hyperaldosteronism
enzalutamide - this is an antagonist for the adrenal hormone binding inside the cellular cytoplasm
radium-233 - preferentially taken up by the mets
what subtype of ovarian CA is the most nasty?
the serous subtype has the worst 5 year survival, but all are pretty bad
what is the role of CEA?
really only used to see response to reduction surgery
no role is monitoring for recurrence, prognosis or diagnosis
what are the PARP-inhibitors?
these are useful in BRCA mutation cancers
the regular repair mechanisms for a cell are two modes:
1. homologous recombination (base the repair off the matching DNA strand)
the BRCA mutation impairs this function
- base-excision repair (removal of the base somehow?)
the PARP1 gene is responsible for this.
The PARP1 inhibitors impair this function, and so, in a cancer cell with both BRCA and PARP1, you can essentially remove the cancer cell’s self repair mechanism
what is the treatment for locally advanced cervical cancer?
radiotherapy with possibly chemotherapy (cisplatin)
once there is distant mets, then we use platinums or taxanes
there may be a role for VEGF inhibitor bevacizumab
how does elevated bhcg cause gynaecomastia?
the bhcg works on the testicles and upregulates the aromatase activity in Leydig cells
this leads to increased oestrodiol activity
what are the three major antibodies associated with paraneoplastic syndrome?
what sorts of cancers are they associated with
Anti-Hu from SCLC, sarcoma, neuroblastoma
Anti-Yo from ovary, uterus, breast and SCLC
Anti-Tr from HL and NHL
what is the cut off size for adrenal CA v adrenal incidentaloma?
what is the Hounslow unit cut off?
4cm
10 HU
