Urogenital Cancer Flashcards
Renal cancer incidence
2-3% of cancers in adults
Increasing incidence
M>F
Risk factors for renal cancer
Smoking
Obesity
Hypertension
2-3% are familial - von hippel-lindau syndrome - vHL gene mutation - clear cell type
Treatment of renal cancer
If localised = nephrectomy for cure
Even if metastatic = nephrectomy to increase response to treatment
Most are clinically silent until locslly advanced or metastatic
VEGF pathway inhibition
mTOR inhibitors
Sunitinib
Inhibits VEGF receptor, PDGF receptor and cKIT oncogene
Oral drug
1st line for renal cancer
Side effects:
- HYPERTENSION
- Hemorrhage
- Hand and foot syndrome
- V and D
- Hypothyroidism
- Neutropenia and thrombocytopenia
- LFT dysfunction
Sorafenib
Inhibits VEGF, PDGF, FGF, CRAF and BRAF
2nd line
Side effects same as sunitinib - look for HTN
Bevacizumab
Antibody to VEGF
? use of bev and TKIs combo
mTOR inhibitors
Increased mTOR –> increased HIF –> increased tumour proliferation, growth, survival and angiogenesis
Temsirolimus and Everolimus
Side effects:
- Mucositis
- N and A
- infection
- anaemia
- Rash
- Hyperglycaemia and hyperlipidaemia
- Pneumonitis
Prostate cancer incidence
1 in 8 men in lifetime
Increasing incidence with increasing age
Rate stable
5yr survival 84%
Treatment of early stage prostate cancer
Lack of data:
- surveillance
- Radical prostatectomy
- EBRT/brachytherapy
Young patients should have surgery
Older patients = radiotherapy
Predictors of relapse of prostate cancer
High Gleason score - 8-10
PSA doubling time <10 months
Adjuvant therapy for locally advanced disease
Surveillance
Radiotherapy
Hormonal therapy - 2yrs recommended
Combined therapy
Treatment options for metastatic prostate cancer
Hormonal therapy
Chemotherapy for CRPC
Bisphosphonates for bone mets
Androgen deprivation therapy
1st line = GnRh agonists +/- Docetaxel
- Must have testosterone antagonist on commencement of treatment
2nd line = GnRH agonists and testosterone antagonists
3rd line = inhibitors of androgen steroidal synthesis - ketoconazole
High volume disease = hormone and docetaxel
Majority of cancers become hormone refractory in18-24 months
Treatment for castration resistant prostate cancer
Docetaxel:
- inhibits disassembly of microtubules during cell cycle progression
- Inhibits bcl-2 –> apoptosis
Side effects:
- Alopecia, N+V, pancytopenia, diarrhoea, lethargy
- Fluid retention
- Peripheral neuropathy
Survival benefit - 24 months
What about docetaxel resistant cancers?
Cabazitaxel and abiraterone acetate
Use of bisphosphonates in prostate cancer
Role:
- Prevents osteopenia with ADT
- Prevents complications of bone mets
- Relieves bone pain from mets
Need calcium and vitamin D supplementation
May cause flare in pain on commencement
Testicular cancer incidence
Rare cancer
75% <40yrs
95% are germ cell tumours - seminomas and NSGCTs
Risk increased with cryptorchidism
> 90% cure rate
Good prognostic factors for testicular cancer
Seminoma:
- Any primary site
- No nonpulmonary visceral mets
- Normal alpha fetoprotein
- Any Beta hCG and LDH
NSGCT:
- Tesicular or retroperitoneal primary
- No nonpulmonary mets
- AFP <1000
- BhCG <5000
- LDH <1.5xULN
Poor prognostic factors for testicular cancer
Not applicable to seminoma
NSGCT:
- Mediastinal primary
- AFP >10 000
- BhCG > 50 000
- LDH >10x ULN
Treatment for stage 1 NSGCT
Radical inguinal orchidectomy
Surveillence with markers and imaging regularly
? 1-2 cycles of bleomycin + etoposide + cisplatin
Why is resection of teratoma important?
Teratoma = curable
In 10-15yrs transforms into adenocarcinoma which is incurable
Must resect when benign
Treatment of stage 1 seminomas
Radical inguinal orchidectomy
Active surveillence regular imaging and tumour markers
Treatment of metastatic testicular cancer?
70% curable with BEP
Side effects of BEP:
- N+V, alopecia, lethargy
- Pancytopenia
- Hypersensitivity to bleo
- Pneumonitis due to bleo
- Peripheral neuropathy, tinnitus and renal impairment from cisplatin
Resect residual masses
