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CAMRT Exam > GU > Flashcards

GU Flashcards

1
Q

Lymphatics

  1. prostate
  2. bladder
  3. testis
  4. penis
A
  1. periprostatic-obturator-ext iliac
  2. ext + int iliac nodes-pre sacral iliac nodes
  3. internal inguinal ring-retroperitoneal LN
  4. inguinal
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2
Q

Metastasis

  1. prostate
  2. bladder
  3. testis
  4. penis
A
  1. bones liver lungs
  2. lung bone liver
    3.
  3. uncommon
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3
Q

Prognostic indicators

  1. prostate
  2. bladder
  3. testis
  4. penis
A
  1. stage & histological differentiation
  2. stage (depth of tumour)
    grade
  3. non-seminoma–>mediastinal primary=poorer prognosis
  4. none
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4
Q

Pathology

  1. prostate
  2. bladder
  3. testis
  4. penis
A

1, adenocarcinoma

  1. transitional
  2. Germ cell
    a) seminoma MC
    b) non-seminoma
  3. SCC
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5
Q

S&S

  1. prostate
  2. bladder
  3. testis
  4. penis
A
  1. urinary frequency
  2. gross painless hematuria
  3. painless mass in scrotum
  4. ulcerative lesion
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6
Q

Epi/Eti

  1. prostate
  2. bladder
  3. testis
  4. penis
A
  1. MC malignancy in males
    Age, race, genetics
  2. Male dominance
    smoking and occupational exposure
  3. personal history, family history and cryptochidism
  4. rare
    not being circumsized
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7
Q

Disease management Prostate

A

T1-2, G2-6, PSA <10, life expectancy <10yrs = observation

T1-2, +ve LN, life expectancy >10yrs= radical proctectomy

ADT deprives tumour of testosterone (for intermediate or high risk)

Chemo- for metastatic disease after ADT fails

RT combined with other modalities

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8
Q

What structures are included in RT volume for intact low and intermediate prostate ca?

A

Prostate +/- seminal vesicles

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9
Q

What structures are included in the RT volume for intact high risk prostate ca?

A

Prostate +/- seminal vesicles +/- pelvic nodes

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10
Q

Disease management Bladder

A

Ta-T1
-Transurethral Resection of Bladder Tumour TURBT

Low grade and small
-partial cystectomy

T2-T4a
-Radical cystectomy

chemo–>if unresectable the chemo is primary therapy

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11
Q

Disease management testis

A

Sx; primary- radical inguinal orchiectomy

(testis are NOT removed through the scrotum b/c increased risk of seeding

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12
Q

Prostate Dose

A

EBRT only
-T1-2, PSA <10, Gleason <7
Conventional: 72-76 (200/fx)
Hypo: 60-72.8 (260-300/fx)

Prostate + regional LN
-T3-4, PSA >10, G>7
Conventional: 78/39 to prostate & 46/23 or 50/25 to LN
Hypo; 70/28 to prostate & 50.4/28 to LN

EBRT- prostate bed
-60/30, 66/33 to bed and 46/23 to LN

Prostate only SBRT
3256/5

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13
Q

Bladder Dose

A

Pre-op
-Tumour >4cm, T3 or T4 45Gy/25

Post op
-45-50Gy

Primary RT:
-64-70 (180-200/fx)
only 45Gy given to whole pelvis LN

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14
Q

Testis dose

A

Seminoma
Stage I &IIA
23MV APPA 20/10

Stage IIB
2500/160-180 of 20/10
additional boost to tumour and margin of 500-1000/ 160-180

Non-seminoma
RT has little roll

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15
Q

Field Border Prostate

A

Sup: L5/S1
Inf: Past bottom of obturator foramen
Ant: pubic symphysis
Post: past ischium /mid rectum

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16
Q

Bladder field borders

A

Phase 1: tx field includes- total empty bladder and tumour and pelvic LN
Phase 2: tumour site/bed +2cm margin
bladder may be full or empty for boost

17
Q

Testis field border

A

Seminoma (hockey stick)
Sup: T10
Inf: bottom of L5
lat: include any PA LN and renal hilum-10cm wide and contralateral testicular shielding

18
Q

Penis RT

A

POP or 1 ANT field
Circumsized
bolus

19
Q

Localized very low or low risk prostate ca

no nodal or distant mets

A

T2a or below
(T1c or below=very low risk)
Grade 1 and PSA <10

If life expectancy <10

  • AS
  • EBRT or brachy
  • radical proctectomy
20
Q 
intermediate risk prostate ca
T2b-T2c
grade 2 or 3
PSA 10-20
No nodal or distant met
A

Life expectancy <10
-WW -AS -EBRT +/-ADT (4-6mo) -Brachy alone

Life expectancy >10
-EBRT +/-ADT (4-6mo)+/-brachy
-Brachy alone
or RP

21
Q

High risk of very high risk no nodal or distant mets

T3a

A

EBRT +ADT (1.5-3yrs)
EBRT + brachy +/-ADT
RP

22
Q

Treatment with nodal mets

A

EBRT + ADT (1.5-3yrs)
or
ADT alone

23
Q

Treatment where there is distant mets

A

ADT +/- chemo

CAMRT Exam (12 decks)

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