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Urology Topics > Topic List 2 - Urooncology > Flashcards

Topic List 2 - Urooncology Flashcards

1
Q

Groups of antineoplastic drugs - Kidney tumors

A

Not sensitive to chemotherapy
Immunotherapy: Interferon alpha2, IL-2
Targeted therapy: VEGF blocking drugs

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2
Q

Groups of antineoplastic drugs - tumors of pyelon and ureter

A

Gemzar-cisplatin
M-VAC: Methotrexate, Vinblastine, Adriamycin, Cisplatin

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3
Q

Groups of antineoplastic drugs - Bladder

A

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)

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4
Q

Groups of antineoplastic drugs - Prostate

A

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

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5
Q

Groups of antineoplastic drugs - Testes

A

Chemotherapy if vascular or lymphatic invasion:
- BEP: Bleomycin, Etoposide, Cisplatin
- PVB: Cisplatin, Vinblastine, Bleomycin

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6
Q

Groups of antineoplastic drugs - Penis

A

Chemotherapy:
- Vincristine, MTX, Bleomycin, 5-FU, Cisplatin

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7
Q

Groups of antineoplastic drugs - Alkylating agents

A
  1. Bleomycin - intercalating
  2. Cisplatin - platinum
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8
Q

Groups of antineoplastic drugs - Antimetabolites

A
  1. Methotrexate - Folate
  2. 5-FU - Pyrimidine analogues
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9
Q

Groups of antineoplastic drugs - Topoisomerase inhibitors

A
  1. Doxorubicin
  2. Epirubicin
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10
Q

Groups of antineoplastic drugs - Mitotic spindle inhibitors

A
  1. Vincristine/Vinblastine - Vinca alkaloids
  2. Docetaxel - Taxanes
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11
Q

What are benign tumors of the kidney

A
  1. Angiomyolipoma
  2. Adenoma
  3. Oncocytoma
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12
Q

What are malignant tumors of the kidney

A
  1. Adenocarcinoma (82%)
    - Clear cell, papillary, chromophobe, bellini tumor
  2. Sarcoma
  3. Lymphoma
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13
Q

What is the classic triad of Renal cell carcinoma?

A
  1. Hematuria
  2. Flank pain
  3. Palpable abdominal mass
    Only 10-15% of the patients present like this though
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14
Q

Kidney tumors - Treatment

A
  1. Surgery (first choice) Most important by far
  2. Immune therapy: Alpha2 interferon, IL-2
  3. Chemotherapy: Vinblastine, 5-FU
  4. Bisphosphonate therapy
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15
Q

Kidney tumors - typical areas of metastasis

A

Lung, liver, brain, bone

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16
Q

Kidney tumor specific - classifications

A

Robson’s
Fuhrmann

17
Q

Tumors of the pyelon and ureter

A

10% of renal tumors and 5% of urothelial tumors
Peak incidence: 70-90 years old; smoking
Hereditary: HNPCC
60% are invasive

18
Q

Superficial bladder cancer - types (histology)

A
  1. Transitional cell carcinoma (90%)
  2. Adenocarcinoma (3-4%)
  3. SCC (2-3%)
  4. Rhabdomyosarcome, leiomyosarcome, lymphoma, melanoma (<1%)
19
Q

Bladder cancer diagnosis

A
  1. History: Painless hematuria, irritative symptoms (frequency, urgency, dysuria)
  2. Physical: Nothing unless super advanced
  3. Labs: Urinalysis, Anemia, SeCr/SeUr increased
  4. US
  5. Cystoscopy
  6. CT
  7. MRI
    8.Urine cytology
20
Q

Superficial Bladder cancer - Treatment

A
  1. TURB
  2. Adjuvant treatment - intravesical instillation
    - indications: Rapid tumor recurrence, multicentricity, invasion, presence of carcinoma in-situ
  3. Chemotherapy - Mitomycin C, Epirubicin, Doxorubicin
21
Q

Invasive Bladder Cancer (T2 and up) - Treatment

A
  1. Radical cystectomy
    -Males: Bladder + prostate + vesicles + parailiac lymph are removed
    -Females: Bladder + uterus + upper third of vagina are removed
  2. Urinary deviation: Percutaneous nephrostomy or ureterocutaneostomy
  3. Chemotherapy:
    -M-VAC (methotrexate, vinblastine, adriamycin, cisplatin)
    -Gemzar-cisplatin
22
Q

Prostate cancer - Epidemiology and Etiology

A

Epidemiology:
-Hungary 4500 each year, 1400 die

Etiology:
-Genetics
-Hormonal
-Environmental

23
Q

Prostate cancer scoring system

A

Gleason score: Based on histology glandular formation
Well differentiated 1-3
Medium 4-7
Poor differentiation 8-10

24
Q

Prostate cancer diagnosis

A
  1. DRE
  2. PSA
  3. Transrectal US (80% nothing can be seen on US)
  4. Biopsy (6 samples each lobe, 12 total)
  5. MRI
  6. PCA3 (prostate cancer antigen 3)
25
Q

Where does prostate cancer normally metastasize?

A

Lungs and Bones

26
Q

Localized prostate cancer (T1-T2) treatment

A
  1. Radical prostatectomy (prostate, lymph, seminal vesicles)
    -Perineal
    -Retropubic
    -Laparoscopic
    -SE: incontinence, ED, loss of libido, Urethral anastomosis stricture
  2. 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
27
Q

Advance Prostate Cancer (T3-T4) Treatment

A

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)

28
Q

Penile tumors - Clinicopathology

A

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%)

29
Q

Penile tumors - Lymphatic spread

A

Superficial and deep inguinal lymph nodes then to iliac nodes
Sentinel node = pubic tubercle and superficial epigastric vein

30
Q

Penile low risk precancerous lesions

A
  1. Balanitis xerotica
  2. Cornu cutaneum
  3. Bowenoid papulosis
31
Q

Penile high risk precancerous lesions

A
  1. Lichen sclerosis
  2. Erythroplasia glandis
  3. Zoon balanitis
  4. Bowen disease
  5. Buschke lowenstein tumor
32
Q

Penile tumor treatment

A
  1. Surgery/excision
  2. Lymphadenectomy
  3. Chemo: 5-FU, Bleomycin, MTX
  4. Radiotherapy
33
Q

Testicular tumor - epidemiology and etiology

A

20-45 years old
95% of all testicular tumors are germ cell
Associated with undescended testes, cryptorchid testes, family and personal history

34
Q

Testicular tumors - Germ cell

A

Seminomas
Non-seminomatous:
-Embryonal
-Teratoma
-Choriocarcinoma
-Mixed

35
Q

What are some chemical markers of testicular tumors?

A

α-Fetoprotein: elevated in yolk sac tumor
β-HCG: elevated in choriocarcinoma
LDH: elevated in seminoma and embryonal carcinoma

36
Q

Testicular tumors - Non-germ cell

A
  1. Leydig cell tumors (Reinke crystals on histology)
  2. Sertoli cell tumors
37
Q

Testicular tumor - staging

A

Stage 1: local
Stage 2: retroperitoneal lymph node involvement
Stage 3: distant metastasis

Urology Topics (2 decks)

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