Topic List 2 - Urooncology Flashcards
Groups of antineoplastic drugs - Kidney tumors
Not sensitive to chemotherapy
Immunotherapy: Interferon alpha2, IL-2
Targeted therapy: VEGF blocking drugs
Groups of antineoplastic drugs - tumors of pyelon and ureter
Gemzar-cisplatin
M-VAC: Methotrexate, Vinblastine, Adriamycin, Cisplatin
Groups of antineoplastic drugs - Bladder
Superficial bladder cancer
- Mitomycin C, Epirubicin, Doxorubicin
Invasive bladder cancer
- M-VAC: Methotrexate Vinblastine, Adriamycin, Cisplatin
- Gemzar- cisplatin
Immunotherapy after TURB: BCG vaccine (Super weird, but makes it memorable)
Groups of antineoplastic drugs - Prostate
Advanced Disease:
Hormonal therapy:
1. Antiandrogens: Flutamide
2. LHRH agonist: Triptorelin
Chemotherapy:
3. Docetaxel/Cabazitaxel
Secondary hormonal therapy:
4. Abiraterone
5. Enzalutamide
Bone metastasis:
6. Alpharadin irradiation
7. Bisphosphonates
Groups of antineoplastic drugs - Testes
Chemotherapy if vascular or lymphatic invasion:
- BEP: Bleomycin, Etoposide, Cisplatin
- PVB: Cisplatin, Vinblastine, Bleomycin
Groups of antineoplastic drugs - Penis
Chemotherapy:
- Vincristine, MTX, Bleomycin, 5-FU, Cisplatin
Groups of antineoplastic drugs - Alkylating agents
- Bleomycin - intercalating
- Cisplatin - platinum
Groups of antineoplastic drugs - Antimetabolites
- Methotrexate - Folate
- 5-FU - Pyrimidine analogues
Groups of antineoplastic drugs - Topoisomerase inhibitors
- Doxorubicin
- Epirubicin
Groups of antineoplastic drugs - Mitotic spindle inhibitors
- Vincristine/Vinblastine - Vinca alkaloids
- Docetaxel - Taxanes
What are benign tumors of the kidney
- Angiomyolipoma
- Adenoma
- Oncocytoma
What are malignant tumors of the kidney
- Adenocarcinoma (82%)
- Clear cell, papillary, chromophobe, bellini tumor - Sarcoma
- Lymphoma
What is the classic triad of Renal cell carcinoma?
- Hematuria
- Flank pain
- Palpable abdominal mass
Only 10-15% of the patients present like this though
Kidney tumors - Treatment
- Surgery (first choice) Most important by far
- Immune therapy: Alpha2 interferon, IL-2
- Chemotherapy: Vinblastine, 5-FU
- Bisphosphonate therapy
Kidney tumors - typical areas of metastasis
Lung, liver, brain, bone
Kidney tumor specific - classifications
Robson’s
Fuhrmann
Tumors of the pyelon and ureter
10% of renal tumors and 5% of urothelial tumors
Peak incidence: 70-90 years old; smoking
Hereditary: HNPCC
60% are invasive
Superficial bladder cancer - types (histology)
- Transitional cell carcinoma (90%)
- Adenocarcinoma (3-4%)
- SCC (2-3%)
- Rhabdomyosarcome, leiomyosarcome, lymphoma, melanoma (<1%)
Bladder cancer diagnosis
- History: Painless hematuria, irritative symptoms (frequency, urgency, dysuria)
- Physical: Nothing unless super advanced
- Labs: Urinalysis, Anemia, SeCr/SeUr increased
- US
- Cystoscopy
- CT
- MRI
8.Urine cytology
Superficial Bladder cancer - Treatment
- TURB
- Adjuvant treatment - intravesical instillation
- indications: Rapid tumor recurrence, multicentricity, invasion, presence of carcinoma in-situ - Chemotherapy - Mitomycin C, Epirubicin, Doxorubicin
Invasive Bladder Cancer (T2 and up) - Treatment
- Radical cystectomy
-Males: Bladder + prostate + vesicles + parailiac lymph are removed
-Females: Bladder + uterus + upper third of vagina are removed - Urinary deviation: Percutaneous nephrostomy or ureterocutaneostomy
- Chemotherapy:
-M-VAC (methotrexate, vinblastine, adriamycin, cisplatin)
-Gemzar-cisplatin
Prostate cancer - Epidemiology and Etiology
Epidemiology:
-Hungary 4500 each year, 1400 die
Etiology:
-Genetics
-Hormonal
-Environmental
Prostate cancer scoring system
Gleason score: Based on histology glandular formation
Well differentiated 1-3
Medium 4-7
Poor differentiation 8-10
Prostate cancer diagnosis
- DRE
- PSA
- Transrectal US (80% nothing can be seen on US)
- Biopsy (6 samples each lobe, 12 total)
- MRI
- PCA3 (prostate cancer antigen 3)
Where does prostate cancer normally metastasize?
Lungs and Bones
Localized prostate cancer (T1-T2) treatment
- Radical prostatectomy (prostate, lymph, seminal vesicles)
-Perineal
-Retropubic
-Laparoscopic
-SE: incontinence, ED, loss of libido, Urethral anastomosis stricture - Irradiation
-Extracorporeal irradiation/teletherapy
-Brachytherapy: if PSA<10 and Gleason<6; can be interstitial or intracavital
-SE: Irradiation cystitis and proctitis (rectum); ED, loss of libido
Advance Prostate Cancer (T3-T4) Treatment
Total androgen blockade
1. Antiandrogens (Flutamide): to decrease flare-up phenomenon
2. LHRH agonist: Triptorelin
This works for first few years then resistance builds
Follow-up is done every 3 months for PSA, 6 months for CT and bone scintigraphy
Next Chemotherapy:
3. Docetaxel (first line) Cabazitaxel (2nd line)
4. Abiraterone or Enzalutamide (Secondary hormone therapy)
Penile tumors - Clinicopathology
Primary tumors:
1. Squamous cell carcinoma (95%)
2. Sarcoma, Kaposi, BCC, Melanoma (5%)
Location:
1. Glans (48%)
2. Prepuce (21%)
3. Both (9%)
4. Coronary sulcus (6%)
Penile tumors - Lymphatic spread
Superficial and deep inguinal lymph nodes then to iliac nodes
Sentinel node = pubic tubercle and superficial epigastric vein
Penile low risk precancerous lesions
- Balanitis xerotica
- Cornu cutaneum
- Bowenoid papulosis
Penile high risk precancerous lesions
- Lichen sclerosis
- Erythroplasia glandis
- Zoon balanitis
- Bowen disease
- Buschke lowenstein tumor
Penile tumor treatment
- Surgery/excision
- Lymphadenectomy
- Chemo: 5-FU, Bleomycin, MTX
- Radiotherapy
Testicular tumor - epidemiology and etiology
20-45 years old
95% of all testicular tumors are germ cell
Associated with undescended testes, cryptorchid testes, family and personal history
Testicular tumors - Germ cell
Seminomas
Non-seminomatous:
-Embryonal
-Teratoma
-Choriocarcinoma
-Mixed
What are some chemical markers of testicular tumors?
α-Fetoprotein: elevated in yolk sac tumor
β-HCG: elevated in choriocarcinoma
LDH: elevated in seminoma and embryonal carcinoma
Testicular tumors - Non-germ cell
- Leydig cell tumors (Reinke crystals on histology)
- Sertoli cell tumors
Testicular tumor - staging
Stage 1: local
Stage 2: retroperitoneal lymph node involvement
Stage 3: distant metastasis