[ROQs] GU, Misc

Question 1

What is the T staging for renal cancer?

Answer 1

• T1/2: Limited to the kidney:
  – T1a: ≤ 4 cm, limited to the kidney
  – T1b: > 4 cm but ≤ 7 cm, limited to the kidney
  – T2a: > 7 cm but ≤ 10 cm, limited to the kidney
  – T2b: > 10 cm, limited to the kidney
• T3: Vasculature Invasion
  – T3a: extends into the renal vein or branches, or invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia
  – T3b - Extends into the vena cava below the diaphragm
  – T3c - Extends into the vena cava above the diaphragm or invades the wall of the vena cava
• T4 - Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)

Question 2

What is the N and M staging for renal cancer?

Answer 2

• Regional Lymph Nodes
  – NX: Regional lymph nodes cannot be assessed
  – N0: No regional lymph node metastasis
  – N1: Metastasis in regional lymph node(s)
• Metastases:
  – MX: Distant metastasis cannot be assessed
  – M0: No distant metastasis
  – M1: Distant metastasis

Question 3

What is the AJCC TNM grouping for renal cancer?

Answer 3

• Stage I: T1 N0 M0
• Stage II: T2 N0 M0
• Stage III: T1-2 N1 M0; T3 N0-1 M0
• Stage IV: T4, any N, M0; any T, any N, M1

Question 4

What is the T staging for penile cancer?

Answer 4

• TX: Cannot be assessed
• T0: No evidence of primary tumor
• Tis - Carcinoma in situ (Penile intraepithelial neoplasia; PelN)
• Ta - Noninvasive localized SqCC
• T1:
  – Glans: Tumor involves lamina propria
  – Foreskin: Tumor invades dermis, lamina propria, or dartos fascia
  – Shaft: Tumor invades connective tissue between epidermis and corpora regardless of location
  – All sites w/wo LVSI, PNI, and is not high grade (i.e. grade 3 or sarcomatoid)
  — T1a: Invades subepithelial connective tissue w/o LVSI, w/o PNI, and is not poorly differentiated
  — T1b: Invades subepithelial connective tissue w/ LVSI, w/ PNI, or is poorly differentiated
• T2: Invades corpus spongiosum w/wo urethral invasion
• T3: Invades corpora cavernosum w/wo urethral invasion
• T4: Invades adjacent structures (i.e. scrotum, prostate, pubic bone)

Question 5

What is the N staging for penile cancer?

Answer 5

• Clinical N:
  – NX
  – N0
  – N1: Palpable mobile unilateral inguinal LN (just 1)
  – N2: Palpable mobile multiple or b/l inguinal LNs
  – N3 - Palpable fixed inguinal nodal mass or pelvic lymphadenopathy
• Pathologic N:
  – pNx
  – pN0
  – pN1: ≤ 2 unilateral inguinal LNs w/o ENE
  – pN2: ≥ 3 unilateral LNs, or b/l inguinal LNs w/o ENE
  – pN3 - ENE or pelvic lymph nodes
• M:
  – M0: No distant metastasis
  – M1: Distant metastasis

Question 6

When should post-op RT be considered for penile cancer?

Answer 6

• Consider RT for:
  – +margins
  – LN+
• RT Dose:
  – Inguinal LN: 45-50.4 Gy
  – Gross nodes, ECE, or + margins: 65-70 Gy
• Consider concurrent CHT
  – Cisplatin or Cisplatin/5FU

Question 7

What is the 5-year cancer-specific survival for stage I/II renal cancer (confined to the kidneys)?

Answer 7

Stage I: 91%
Stage II: 76%

Question 8

What is the 5-year cancer-specific survival for stage III renal cancer?

Answer 8

67%

Question 9

What are the most important prognostic factors for renal cell cancer?

Answer 9

• TNM
• Grade

Question 10

Which pts are most appropriate for penile conservation therapy?

Answer 10

• T1-2, N0
• Size < 4 cm
  – Local failure: 12-30%
  – If > 4 cm, local failure: 50-60%
• DOI < 1 cm

Question 11

What is the primary therapy for localized renal cancer?

Answer 11

• Surgical resection

Question 12

What % of penile cancer cases are a/w HPV?

Answer 12

• 45-80%
• HPV 16, 18, 33, 45
• Unclear if this carries an improved prognosis or not

Question 13

What is the most common histology of renal pelvis and ureteral cancers?

Answer 13

• Urothelial: >90%
• SqCC: 4-8%

Question 14

What is the standard management of upper urinary tract tumor?

Answer 14

• Nephrouretectomy
• +resection of bladder cuff at ureterovesical jx

Question 15

What peculiar procedure must be performed prior to consideration of RT for penile cancer?

Answer 15

• Circumcision!
• Decreased RT toxicities

Question 16

What % of inguinal lymphadenopathy from penile cancer may be due to inflammation and not metastatic involvement?

Answer 16

30-50%!

Question 17

What is the local control of SABR for primary tx of RCC?

Answer 17

• > 95%
• Low tox
• Single fx regimens optimize control
  – 25 Gy in 1 fx

Question 18

What is a unique, serious complication of penectomy?

Answer 18

Suicide

Question 19

What is Bowen disease?

Answer 19

• Bowen disease:
  – SqCC in situ
  – Precursor of warty and basaloid penile cancer
• Erythroplasia of Queryat (Bowen disease of the glans penis) and bowenoid papulosis are also associated with warty and basaloid penile cancers.
• Over 80% of warty and basaloid penile cancers are HPV-related.

Question 20

What are the common locations of penile cancer?

Answer 20

• Glans: ~50%
• Prepuce (foreskin): ~25%
• Glans + prepuce: ~9%.
• Coronal sulcus: ~6%
• Shaft: ~2%

Hook: Moves from front to back

Question 21

Which tumors/cancers are a/w Von Hippel-Lindau disease?

Answer 21

• Hemangioblastomas of the brain & spine (60-84%)
• Clear cell renal cell cancers (70%)
• Pheochromocytomas
• Retinal angiomas

Question 22

What is the minimum recommended margin for WLE or penetectomy for penile cancer?

Answer 22

• NCCN: 5-10 mm
• European: ≥ 3 mm

Question 23

In penile cancer pts managed w/ upfront RT, what % can be successfully surgically salvaged upon local recurrence?

Answer 23

> 80%

Question 24

In penile cancer pts managed w/ upfront RT, what % will experience local failure?

Answer 24

~60%

Question 25

What is one way to immobilize a penis when treating penile cancer w/ EBRT?

Answer 25

• Prone positioning
• Penis in a water bath