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Oncology Exam 3 > RCC > Flashcards

RCC Flashcards

1
Q

What is the percent surviving at 5 years for RCC?

A

75%

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2
Q

What are the risk factors of RCC?

A

Obesity
Smoking
HTN

Occupational exp, VHL disease

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3
Q

T/F 40% of VHL patients will develop RCC

A

True

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4
Q

T/F 60% of renal cancers are RCC

A

False

90%

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5
Q

Describe sporadic RCC

A

single tumor
one kidney
older patient
known risk factors

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6
Q

Describe hereditary RCC

A

numerous cystic lesions

affects both kidneys

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7
Q

T/F the majority of RCC patients are symptomatic

A

false

Asymptomatic

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8
Q

What is the classic triad of symptoms in RCC?

A

Hematuria
Flank pain
Palpable abdominal mass

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9
Q

Metastatic disease in RCC symptoms

A

Bone pain
Adenopathy
Pulmonary symptoms

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10
Q

T/F screening is recommended for everyone for RCC

A

False

Not for general population!

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11
Q

T/F you must biopsy for diagnosis in RCC

A

False

Radiographic evaluation is usually good enough!

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12
Q

Stage I RCC

A

tumor = 7 cm

Limited to kidney

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13
Q

Stage II RCC

A

tumor > 7 cm

Limited to kidney

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14
Q

Stage III RCC

A

Limited to kidney with metastasis to regional lymph nodes
OR
tumor extends into major veins or perinephric tissues

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15
Q

Stage IV RCC

A

Tumor invades beyond Gerota’s fascia
Or
tumor with distant metastasis

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16
Q

T/F complete resection is needed for a cure in localized and advanced RCC

A

False!
For cure = localized
For disease control = advanced

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17
Q

T/F radiation is only palliative for localized and advanced RCC

A

True

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18
Q

Radical nephrectomy

A

full removal of kidney + fat + adrenal gland + reginal lymph nodes

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19
Q

Risks of radical nephrectomy

A

CKD

CVD

20
Q

When would you use partial nephrectomy?

A

If radical would lead to dialysis
Tumor on both kidneys
Already have 1 kidney
Poor renal fcn

21
Q

T/F adjuvant therapy is a must in RCC

A

False

No benefit!

22
Q

T/F there is a minimal role for traditional chemo in advanced RCC

A

true

23
Q

When can you use IL-2 in RCC?

A

excellent performance status and normal organ function

**lots of toxicities, so given in ICU usually

24
Q

*Nivolumab MOA

A

PD-1 inhibitor
Binds receptor on T cells
Block ligands PD-L1 and PD-L2 from binding

25
Q

1st line therapy for RCC

A

Ipilimumab + nivolumab

26
Q

Ipilimumab MOA

A

CTLA-4 inhibitor

27
Q

*Immunotherapy ADEs

A 
Peripheral edema
Pruritis, rash
N/D
Colitis
Anemia
Cough, pneumonitis
Hypothyroidism
Encephalitis
Hepatitis, nephritis
28
Q

*Management of immune-related ADEs

A

Systemic steroids: prednisone 0.5 - 2 mg/kg/day

29
Q

*Pembrolizumab MOA

A

anti-PD1 inhibitor

30
Q

*1st line therapy for metastatic RCC preferred by NCCN

A

Pembrolizumab + axitinib )

31
Q

*Who can you use pembrolizumab in?

A

favorable or poor/intermediate risk

32
Q

*What are the 5 class ADEs of TKIs?

A
  1. dermatologic (rash, hand-foot)
  2. GI
  3. Hematologic
  4. Hepatic
  5. Cardiac: HTN
33
Q

*Management of hand-foot

A

Control calluses
Comfort with cushions
Cover with creams

avoid vigorous exercise/activity that puts stress on hands or feet

34
Q

When is lenvatinib used?

A

only in combo with everolimus

35
Q

When would you use pazopanib?

A

has less derm toxicities!

36
Q

Which would you choose?

Metastatic RCC worried about dermatological issues

A

Pazopanib

37
Q

Which of these drugs is NOT metabolized by CYP 3A4?

Pembrolizumab, levantinib, sunitinib, axitinib

A

Pembrolizumab

38
Q

Important pearl for cabozantinib

A

tablets and capsules are NOT interchangeable

Increased nausea

39
Q

What was the first FDA approved biological antiangiogenic agent for RCC?

A

bevacizumab

40
Q

BBW bevacizumab

A

impaired wound healing
GI perforation
SAH
pulmonary hemorrhage

41
Q

Main ADEs of temsirolimus

A

metabolic: hyperglycemia, hypercholesteremia, hyperlipidemia

42
Q

Sarcomatoid variant RCC

A

aggressive form of RCC
poor prognosis
*chemo had shown activity here!

43
Q

When would you use traditional chemo in RCC?

A

sarcomatoid

44
Q

Hallmark of clear cell RCC

A

inactivation of VHL

45
Q

What is the treatment of choice for all stages in RCC?

A

surgery

Oncology Exam 3 (6 decks)

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