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Uro Onc > UTUC > Flashcards

UTUC Flashcards

1
Q

UTUC

Suspicious Renal Pelvis Mass Workup

8

A
  • CTU or MRU +/- Chest CT vs CXR
  • Cytology
  • Cystoscopy
  • Ureteroscopy with biopsy, Percutaneous biopsy, and/or selective washings
  • Labs
  • Nuclear medicine renal scan (if indicated)
  • Bone scan (if indicated)
  • Consider germline testing and genetic counseling (if indicated)
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2
Q

UTUC

Suspicious Ureteral Mass Workup

8

A
  • CTU or MRU +/- Chest CT vs CXR
  • Cytology
  • Cystoscopy
  • Ureteroscopy with biopsy, Percutaneous biopsy, and/or selective washings
  • Labs
  • Nuclear medicine renal scan (if indicated)
  • Bone scan (if indicated)
  • Consider germline testing and genetic counseling (if indicated)
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3
Q

UTUC

Metastatic Renal Pelvis UTUC Treatment

5

A
  • Pembrolizumab and enfortumab vedotin (p) (cisplatin eligible or ineligible)
  • Gemcitabine, cisplatin followed by avelumab maintenance
  • Nivolumab, gemcitabine, cisplatin followed by avelumab maintenance
  • ddMVAC followed by avelumab maintenance
  • Gemcitabine carboplatin (cisplatin ineligible)
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4
Q

UTUC

Metastatic Ureteral UTUC Treatment

5

A
  • Pembrolizumab and enfortumab vedotin (p) (cisplatin eligible or ineligible)
  • Gemcitabine, cisplatin followed by avelumab maintenance
  • Nivolumab, gemcitabine, cisplatin followed by avelumab maintenance
  • ddMVAC followed by avelumab maintenance
  • Gemcitabine carboplatin (cisplatin ineligible)
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5
Q

UTUC

Second- and Third-line chemotherapy

12

A

Post-platinum
* Pembrolizumab (p)
* Nivolumab
* Avelumab
* Erdafitinib
* Enfortumab vedotin

Post-ICI
* Enfortumabd vedotin (p)
* Gemcitabine cisplatin (cisplatin eligible)
* Gemcitabine carboplatin (cisplatin ineligible)
* Erdafitinib
* ddMVAC (cisplatin eligible)

Third-line
* Erdafitinib
* Enfortumab vedotin

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6
Q

UTUC

First-line Chemotherapy

5

A
  • Pembrolizumab and enfortumab vedotin (p) (cisplatin eligible or ineligible)
  • Gemcitabine, cisplatin followed by avelumab maintenance
  • Nivolumab, gemcitabine, cisplatin followed by avelumab maintenance
  • ddMVAC followed by avelumab maintenance
  • Gemcitabine carboplatin (cisplatin ineligible)
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7
Q

UTUC

Low Grade Renal Pelvic UTUC Treatment

2

A
  • Endoscopic resection +/- postsurgical chemotherapy or BCG
  • Nephrouretectomy with bladder cuff +/- peri-op intravesical chemotherapy
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8
Q

UTUC

High Grade, Large or Parenchymal Invasive Renal Pelvic UTUC Treatment

2

A
  • Nephrouretectomy with bladder cuff +/- peri-op intravesical chemotherapy
  • Cisplatin-based NAC (select pts)
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9
Q

UTUC

Upper Ureteral UTUC Treatment

2

A
  • LG: Endoscopic resection
  • HG: Nephrouretectomy with bladder cuff and regional lymphadenectomy +/- peri-op intravesical chemotherapy +/- Cisplatin-based NAC (select pts)
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10
Q

UTUC

Mid Ureteral UTUC Treatment

3

A
  • LG: Endoscopic resection
  • HG: Nephrouretectomy with bladder cuff and regional lymphadenectomy +/- peri-op intravesical chemotherapy +/- Cisplatin-based NAC (select pts)
  • Excision and ureteroureterostomy/ ileal ureter +/- perioperative intravesical chemotherapy (select pts)
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11
Q

UTUC

Distal Ureteral UTUC Treatment

3

A
  • LG: Endoscopic resection
  • HG: Nephrouretectomy with bladder cuff and regional lymphadenectomy +/- peri-op intravesical chemotherapy +/- Cisplatin-based NAC (select pts)
  • Distal ureterectomy and regional lymphadenectomy and reimplantation +/- perioperative intravesical chemotherapy (select pts) +/- Cisplatin-based NAC (select pts)
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12
Q

UTUC

Adjuvant therapy

3

A
  • pT1 or lower: surveillance
  • pT2 or higher or pN+: adjuvant cisplatin based chemo (if not given previously) (p) or adjuvant nivolumab
  • ypT2 or higher or ypN+: consider nivolumab
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13
Q

UTUC

Tis Ta T1 Staging

3

A

Tis -> Carcinoma in situ
Ta -> Noninvasive
T1 -> Invades subepithelial connective tissue

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14
Q

UTUC

T2 Staging

1

A

T2 -> Invades muscularis

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15
Q

UTUC

T3 Staging

1

A

T3 -> Invades into peripelvic fat, periureteral fat or parenchyma

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16
Q

UTUC

T4 Staging

1

A

T4 -> Invades adjacent organs or through the kidney into perinephric fat

17
Q

UTUC

N Staging

2

A

N1 -> Single LN less than 2cm
N2 -> Single LN greater than 2cm or multiple LNs

18
Q

UTUC

M Staging

1

A

M1 -> Distant metastasis

19
Q

UTUC

Stage I-IV

4

A

Stage I -> T1 N0 M0
Stage II -> T2 N0 M0
Stage III -> T3 N0 M0
Stage IV -> T1-4, N0-2, M0-1

Uro Onc (19 decks)

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