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Urology General > Oncology > Flashcards

Oncology Flashcards

1
Q

Probability of CA prostate:
PSA 4 - 10: _
fPSA 0 - 10%: _
fPSA > 25%: _

A

25%
56%
8%

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2
Q

What are the types of biomarkers for CAP

A

blood
urine
tissue

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3
Q

what is PCA3

A

PPMU

Previous negative biopsy

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4
Q

What is ExoDx / SelectMDx

A

1st catch urine
PSA 2 - 10
No prior biopsy

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5
Q

CAP
Lifetime risk 1 in _
_ in 5th decade
_ in 9th decade

A

9
30%
60%

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6
Q

what is PCPT

Findings

A

RCT: finasteride vs placebo
More GS7+
No difference in CSS (15y)

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7
Q

what is Hopkins criteria

A

.

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8
Q

what is the risk of CAP if there are two 1st degree relatives involved?

A

5 - 11x

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9
Q

what are the characteristics of prostate ductal CA?

A

0.4 - 0.8%

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10
Q

what are prostate STUMPs?

A

PZ
Degenerative atypia
60s

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11
Q

CAP will have
__ Ki-67 staining
__ cytokeratin staining

A

High (cell proliferation marker)

Low

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12
Q

CAP staging

N1

A 
regional LN (pelvic)
M1a: nonregional LN = extrapelvic LN
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13
Q

ERSPC
RRR in CSM: _
NNT: _
Difference in OS: _

A

21%
27
NO

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14
Q

PLCO

RRR in CSM

A

NO

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15
Q

Goteborg

RRR in CSM

A

44%

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16
Q

what is PIN / HGPIN?

A

HGPIN 5%

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17
Q

what is ASAP

A

0.4mm in diameter

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18
Q

what is cs CAP?

A

Epstein

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19
Q

what is Polaris

A

Cell cycle progression

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20
Q

what is Oncotype Dx

A

Genomic prostate score GPS

0 - 100

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21
Q

what is Decipher

A

Genomic classifier

0 - 1

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22
Q

Exclusion criteria of AS for CAP

A

EAU 2019/2020 consensus

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23
Q

what is ProtecT study?

A

Prostate cancer testing and treatment
AS RP RT
No difference in OS
More progression in AS

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24
Q

what is PIVOT ?

A

Prostate cancer intervention versus observation trial
AS RP
No difference in CSS / OS

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25
Q

RP

NNT

A

SPCG-4
8
4 (< 65y)

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26
Q

SPCG-4 results - death ARR:
Whole cohort
>= 65y
Low / int / high-risks

A

12.7%
NS
15%/15%/NS

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27
Q

PIVOT results - death ARR:
Whole cohort
Low/int/high-risks

A

NS

NS/12.6%/NS

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28
Q

Results of REACTT by Montorsi

A

Better IIEF @ 9m

Reduces loss of penile length by 4mm

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29
Q

what does MASTER trial show?

A

Equally effective

But AUS: better satisfaction, lower leak, few repeat, lower pain/infection

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30
Q

what defines biochemical recurrence of CAp after RP

A

Two 0.2

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31
Q

what does RADICALS tell us?

A

5y-BCPFS

Two consecutive rises > 0.1, or three consecutive rises

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32
Q

Hormonal tx for CAP undergoing RT
Node +ve: _
Node -ve: _

A

Node +: lifelong

Node -: neoadj if int+; adj if high risk

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33
Q

Give examples of brachytherapy agents in CAP

A

Low dose rate LDR: Iodine-125; Palladium-103

High dose rate HDR: iridium-192

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34
Q

CI for brachytherapy in CAP

A 
60cc
TURP
High risk
Bleeding tendency
Severe LUTS
Pelvic RT
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35
Q

what is Phoenic definition?

A

Nadir + 2

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36
Q

Mechanism of cell death in cryo

A

4

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37
Q

Mechanism of cell death in HIFU

A

3

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38
Q

what study supports ADT in non-met CAP?

A

EORTC Studer: OS

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39
Q

what study supports ADT in met CAP?

A

MRC trial: CSS

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40
Q

what study support adj ADT in high risk CAP undergoing RT?

A

RTOG 9292

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41
Q

what study supports iADT?

A

SWOG 9346

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42
Q

Half life of bicalutamide

A

5 days

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43
Q

what is the risk of fracture in patients receiving ADT?

A

20% in 5y

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44
Q

how many cycles of docetaxel for met CAP?

A

6

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45
Q

what is docetaxel?

A

2nd gen
anti microtubular
inhibit disassembly

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46
Q

definition of high-volume mets in CAP

A

4 bone with 1 outside

1 visceral

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47
Q

definition of high-risk disease in met CAP

A

GS8
3 bone
1 visceral

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48
Q

definition of CRPC

A

3

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49
Q

what is abiraterone?

A

CYP17

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50
Q

SE of abiraterone

Why prednisolone?

A

mineralocorticoid, myopathy

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51
Q

what is enzalutamide

A

AR antagonist
androgen-receptor complex
transportation, DNA binding

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52
Q

SE of enza

A 
fatigue
fracture
seizure
HT
cognitive
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53
Q

SE of apalutamide

A

hypoT
rash
diarrhea
fracture

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54
Q

what does CARD study tell us?

A

3rd line after failed chemo and AR

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55
Q

what is PARP inhibitor?

A

poly ADP-ribose polymerase inhibitor

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56
Q

what does TOPARP tell us?

A

33% had DNA repair genes mutations

in those failed multi lines

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57
Q

what does PROfound tell us?

A

rPFS for failed AR + DNA repair+

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58
Q

what does TRITON2 tell us?

A

ORR 43% for BRCA + failed chemo + AR

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59
Q

what is FoundationOne Liquid CDx?

A

FDA
Liquid biopsy
ctDNA in blood
> 300 genes

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60
Q

what are the differences between TheraP and VISION study?

A

post AR
Discordant disease
OS data

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61
Q

what are the differences between bisphosphonate and denosumab?

A

Mechanism
Administration
Applicability
SE

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62
Q

How RB works?

A

TS suppressor protein
(when non-phosphorylated) sequester E2F
Blocks entry to S phase

63
Q

How p53 works?

A

Phosphorylation of p53 leads to G1/S arrest

64
Q

CA bladder
RR for smoking: _
RR for stopping smoking: _

A

3X

40%

65
Q

Ca bladder

M : F = ?

A

4 : 1

66
Q

Describe lifecycle of schistosomiasis

A

Miracidia
Sporocyst
Cercariae
Adult

67
Q

Name urine biomarkers for CA bladder

A

NMP22
BTA
Immuno-cyt
UroVysion

68
Q

Efficacy of BLC in CA bladder

A

10% ARR for recurrence in low risk

69
Q

Efficacy of NBI in CA bladder

A

20% ARR in recurrence (CROES)

70
Q

What are von Hansemann cells and Michaelis-Gutmann bodies?

A

Large eosinophilic granular histiocytes

Basophilic laminar inclusion bodies

71
Q

CA bladder staging

what is N2 , N3

A

> 1 nodes in true pelvis

Common iliac node

72
Q

Name some characteristic genetic changes in low and high-risk NMIBC.

A

Low: loss of heterozygosity ch9, activating mutation FGFR3 ch4

High: p53, Rb, PTEN, ch9 deletion

73
Q

what is gemcitabine?

A

cytosine analogue
triphosphate
elongating dna chain
inhibit synthesis

74
Q

what is BCG failure

A

BCG intolerant
BCG relapse
BCG refractory

75
Q

what does HYMN trial tell us?

A

RITE, MMC

Better DFS in papillary-only disease

76
Q

efficacy of pembro in BCG-failure NMIBC

A

CIS disease

41% CR

77
Q

what is encoded by the gene carried by Nadofaragene?

A

IFNa-2b

78
Q

Ca bladder

__ had muscle invasion at presentation

A

57%

79
Q

what is cisplatin?

A

alkylating agent

80
Q

CA bladder

pCR for neoadj chemo

A

~ 30%

81
Q

CA bladder

___ of cN0 will have pN+

A

25%

82
Q

CA bladder

Indication of urethrectomy

A

2

83
Q

CA bladder

role of adjuvant immuno?

A

Nivolumab 1y

Better DFS than placebo

84
Q

CA bladder - risk of distant recurrences after RC
pT2
pT3
pT4

A

20%
40%
>50%

85
Q

Met CA bladder

Addition of pembro to cisplatin provide OS benefit: T / F

A

False

86
Q

Role of avelumab in met CA bladder

A

Better OS as maintenance tx (over supportive care)

87
Q

What is Amsterdam criteria?

A 
3 relatives
1 + 2
2 successive
1 < 50y
FAP exc
88
Q

UTUC staging

N1 N2 N3

A

single < = 2cm
2 - 5cm / multiple
> 5cm

89
Q

ODMIT-C: efficacy

A

ARR 11% of 1y recurrence

90
Q

POUT trial

Inclusion and efficacy

A

DFS HR 0.54

91
Q

UTUC

Medican eGFR decline after NU: __

A

18%

92
Q

UTUC - antegrade instillation of BCG

Regimen = ?

A

3 vials in 150ml NS
20cm above
1ml/min
for 2h

93
Q

UTUC

5y-CSS for T3 , T3 with renal sinus fat invasion = ?

A

54%

25%

94
Q

relaitonship of inverted papilloma and CA bladder

A

urothelial CA elsewhere

95
Q

4 associations with adenoCA of bladder

A

urachal
bladder exstrophy
augmentation
cystitis glandularis

96
Q

CA bladder

what mutation is associated with plasmacytoid variant?

A

CDH-1 (E-cadherin) mutations

97
Q 
RCC
Molecular staining:
CC: _ ; _
Papillary: _
Chromophobe: _ ; _
A

CD10; CA9
Type 1: CK7
Hale’s colloidal stain ; CK7

98
Q

Black males / sickle cells + RCC =?

A

Renal medullary CA

99
Q

Translocation-associated carcinoma:

__ % of childhood RCC

A

30%

100
Q

what is paraneoplastic syndrome?

A

systemic manifestation

unrelated to local presence

101
Q 
VHL
Ch:
Gene:
Codes for:
Associations:
A

3p
VHL gene
VHL protein

102
Q 
HPRC
Ch
Gene
Codes for
Associations
A

7
MET
receptor

103
Q 
HLRCC
Ch
Gene
Codes for
Association
A

1
FH gene
FH

104
Q 
BHD
Ch
Gene
Codes for
Associations
A

17
BHD gene
Folliculin
Lung cyst, PTX, fibrofolliculoma

105
Q

What subtype is similar to HLRCC?

Associations

A

SDH-deficient cancer

Phaeo / GIST

106
Q 
RCC staging
what is :
T3c
N1
N2
A

supra-diaphragm / invades wall
N1: regional LNs
NO N2

107
Q

Role of pembro in localised RCC

A

Adjuvant tx for int/high risk: better DFS 9%

108
Q

Metastatic RCC
__ % presents with mets
__ % are solitary

A

20%

1%

109
Q

SE of TKI

A

HT (30%)
Diarrhea
Fatigue, hypoT
Hand foot syndrome

110
Q

Survival benefit of cytoreductive nephrectomy

A

NO

111
Q

RCC: 5y-CSS
T1
T2
T3

A

> 90%
80%
T3a 50%

112
Q

Prognostication for a locally recurrent RCC

Factors = ?

A

> 5cm
Sarcomatoid
PSM
High ALP / LDH

113
Q

IMDC for RCC criteria = ?

Median OS for each group = ?

A

CBC Ca time Karnofsky

43 23 8 months

114
Q

SRM
Chance of benign
< 1cm = ?
3 - 4 cm =?

A

46%

8%

115
Q

SRM

Chance of synchronous mets (i.e. on presentation)

A

< 2%

116
Q

SRM

Mean growth rate = ?

A
  1. 28cm / year

0. 4cm/ year if confirmed RCC

117
Q

PN for SRM:
PSM rate
Ipsilateral recurrence

A

2% (vs 0.4%)

1%

118
Q

SRM
Lap vs. open PN:
PSM rate

A

Same (1%)

119
Q

PN for SRM

Risks of new CKD

A

GFR < 60: 20%

GFR < 30: 17%

120
Q

Mechanism of RFA

A

High freq alt current
ion agitation
frictional heating

121
Q

Cryo for RCC : risks of =
Retreatment
Local progression
Met

A

1.3%
5.2%
1%

122
Q

CA testis
Lifetime risk _
Incidence per 100,000 (young group) _

A

1 in 210

~ 15 (age dependent)

123
Q

UDT for CA testis: RR = ?

A

Overall 3.2
Ipsilateral 6.3
Contralateral 1.7

124
Q

CA testis
_ % has personal hx
_ % has FHx

A

5%

1.8%

125
Q

CA testis

Which confers stronger RR, wrt FHx : sibling vs. father-son?

A

Sibling (X-linked locus)

126
Q

what is microlithiasis?

A

> = 5 non showing echogenic foci
<= 3mm
single sonogram

127
Q

CA testis: raised tumor markers
Overall _
NSGCT _
Seminoma _

A

50%
90%
30%

128
Q

Incidence of GCNIS

A

general population: 0.8%

contralateral tumor: 5 - 10%

129
Q

Testicular bx preservation in __

A

Bouin’s solution

130
Q

T 1/2 of
aFP
B HCG

A

7days

2 days

131
Q

CA testis staging
T1
T2
N1 N2 N3 (ref UTUC)

A

limited to testis
LVI/epididymis/hilar/ext TA
2, 2-5, >5cm

132
Q

Stage 1 seminoma

__% has subclinical mets

A

20%

133
Q

Findings of MRC TE 19

A

Oliver

Relapse-free survival 96% @ 4y for high risk stage 1 seminoma undergoing adjuvant tx

134
Q

Findings of MRC TE 18

A

20Gy
Less lethargy
Relapse rate 0.7% higher than 30Gy
(adjuvant for stage 1 high risk seminoma)

135
Q

Result of SEMPET trial

A

NPV 96% for > 3cm residual retroperitoneal mass (sem post-tx)

136
Q

what is bleomycin?

A

anti tumor agent
metallobleomycin complex
DNA breaks

137
Q

Proportions of disease shown during RPLND for > 1cm residual mass post-chemo for NSGCT

A

10% residual
50% teratoma
40% necrosis

138
Q

What testicular tumor is associated with Klinefelter?

A

Mediastinal GCT

139
Q

what is BXO?

A

chronic inflam

tears/cracks/hyperkeratotic

140
Q

what is 5-FU

A

pyrimidine analogue
non compet inhibit thymidylate synthase
S phase arrest

141
Q

what is imiquimod cream?

A

imidazoquinonin tetracyclicamine
Toll 7 receptor
activate immune cells , cytokine release

142
Q

___% of CA penis has BXO

___% of CA penis has HPV

A

28%

60 - 80%

143
Q

CA penis staging
T1b T2
N1 N2 N3

A

T1b = LVI/HG ; T2 = corpus spongiosum

1-2 ; bilateral or >=3; ECE or pelvic

144
Q 
CA testis (cN0)
The only group of patients who do not need nodal staging
A

T1a G1

145
Q

CA penis

Indication for PLND

A

> 1 inguinal LN

ECE

146
Q

features of benign penile ulcers
syphilis
chancroid
lymphogranuloma venereum

A

ulcer , LN: painful vs. painless
syphilis: painless
chancroid: painful
LG: painless ulcer, painful nodes

147
Q

Any role for neoadj chemo for T3-T4 CA urethra?

A

yes

cisplatin

148
Q

CA urethra

pN+ rate: __ for cN0 disease

A

9% only

149
Q

what is:
Barbagli procedure
Asopa urethroplasty
Kulkarni’s urethroplasty

A

Dorsal stricturotomy + onlay BMG
inlay BMG
One sided dissection , dorsal stricturotomy + onlay BMG

150
Q

what is Orandi flap?

A

stricturotomy + penile skin flap for proximal penile urethral stricture

151
Q

what is radiation?

what is ionizing radiation?

A

emission of energy in wave / particles

high enough energy to remove electron

152
Q

what are the 4 Rs of radiotherapy?

A

normal tissues : repopulate, repair

tumor : reoxygenate, reassortment

153
Q

what is RPF?

A

proliferation of fibro-inflammatory tissue in retroperitoneum

154
Q

what drugs are associated with RPF?

A

B-blocker, methyldopa, phenacetin, bromocriptine, hydralazine…..

Urology General (13 decks)

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