Oncology Flashcards
(154 cards)
1
Q
Probability of CA prostate:
PSA 4 - 10: _
fPSA 0 - 10%: _
fPSA > 25%: _
A
25%
56%
8%
2
Q
What are the types of biomarkers for CAP
A
blood
urine
tissue
3
Q
what is PCA3
A
PPMU
Previous negative biopsy
4
Q
What is ExoDx / SelectMDx
A
1st catch urine
PSA 2 - 10
No prior biopsy
5
Q
CAP
Lifetime risk 1 in _
_ in 5th decade
_ in 9th decade
A
9
30%
60%
6
Q
what is PCPT
Findings
A
RCT: finasteride vs placebo
More GS7+
No difference in CSS (15y)
7
Q
what is Hopkins criteria
A
.
8
Q
what is the risk of CAP if there are two 1st degree relatives involved?
A
5 - 11x
9
Q
what are the characteristics of prostate ductal CA?
A
0.4 - 0.8%
10
Q
what are prostate STUMPs?
A
PZ
Degenerative atypia
60s
11
Q
CAP will have
__ Ki-67 staining
__ cytokeratin staining
A
High (cell proliferation marker)
Low
12
Q
CAP staging
N1
A
regional LN (pelvic) M1a: nonregional LN = extrapelvic LN
13
Q
ERSPC
RRR in CSM: _
NNT: _
Difference in OS: _
A
21%
27
NO
14
Q
PLCO
RRR in CSM
A
NO
15
Q
Goteborg
RRR in CSM
A
44%
16
Q
what is PIN / HGPIN?
A
HGPIN 5%
17
Q
what is ASAP
A
0.4mm in diameter
18
Q
what is cs CAP?
A
Epstein
19
Q
what is Polaris
A
Cell cycle progression
20
Q
what is Oncotype Dx
A
Genomic prostate score GPS
0 - 100
21
Q
what is Decipher
A
Genomic classifier
0 - 1
22
Q
Exclusion criteria of AS for CAP
A
EAU 2019/2020 consensus
23
Q
what is ProtecT study?
A
Prostate cancer testing and treatment
AS RP RT
No difference in OS
More progression in AS
24
Q
what is PIVOT ?
A
Prostate cancer intervention versus observation trial
AS RP
No difference in CSS / OS
25
RP
| NNT
SPCG-4
8
4 (< 65y)
26
SPCG-4 results - death ARR:
Whole cohort
>= 65y
Low / int / high-risks
12.7%
NS
15%/15%/NS
27
PIVOT results - death ARR:
Whole cohort
Low/int/high-risks
NS
| NS/12.6%/NS
28
Results of REACTT by Montorsi
Better IIEF @ 9m
| Reduces loss of penile length by 4mm
29
what does MASTER trial show?
Equally effective
| But AUS: better satisfaction, lower leak, few repeat, lower pain/infection
30
what defines biochemical recurrence of CAp after RP
Two 0.2
31
what does RADICALS tell us?
5y-BCPFS
| Two consecutive rises > 0.1, or three consecutive rises
32
Hormonal tx for CAP undergoing RT
Node +ve: _
Node -ve: _
Node +: lifelong
| Node -: neoadj if int+; adj if high risk
33
Give examples of brachytherapy agents in CAP
Low dose rate LDR: Iodine-125; Palladium-103
| High dose rate HDR: iridium-192
34
CI for brachytherapy in CAP
```
60cc
TURP
High risk
Bleeding tendency
Severe LUTS
Pelvic RT
```
35
what is Phoenic definition?
Nadir + 2
36
Mechanism of cell death in cryo
4
37
Mechanism of cell death in HIFU
3
38
what study supports ADT in non-met CAP?
EORTC Studer: OS
39
what study supports ADT in met CAP?
MRC trial: CSS
40
what study support adj ADT in high risk CAP undergoing RT?
RTOG 9292
41
what study supports iADT?
SWOG 9346
42
Half life of bicalutamide
5 days
43
what is the risk of fracture in patients receiving ADT?
20% in 5y
44
how many cycles of docetaxel for met CAP?
6
45
what is docetaxel?
2nd gen
anti microtubular
inhibit disassembly
46
definition of high-volume mets in CAP
4 bone with 1 outside
| 1 visceral
47
definition of high-risk disease in met CAP
GS8
3 bone
1 visceral
48
definition of CRPC
3
49
what is abiraterone?
CYP17
50
SE of abiraterone
| Why prednisolone?
mineralocorticoid, myopathy
51
what is enzalutamide
AR antagonist
androgen-receptor complex
transportation, DNA binding
52
SE of enza
```
fatigue
fracture
seizure
HT
cognitive
```
53
SE of apalutamide
hypoT
rash
diarrhea
fracture
54
what does CARD study tell us?
3rd line after failed chemo and AR
55
what is PARP inhibitor?
poly ADP-ribose polymerase inhibitor
56
what does TOPARP tell us?
33% had DNA repair genes mutations
| in those failed multi lines
57
what does PROfound tell us?
rPFS for failed AR + DNA repair+
58
what does TRITON2 tell us?
ORR 43% for BRCA + failed chemo + AR
59
what is FoundationOne Liquid CDx?
FDA
Liquid biopsy
ctDNA in blood
> 300 genes
60
what are the differences between TheraP and VISION study?
post AR
Discordant disease
OS data
61
what are the differences between bisphosphonate and denosumab?
Mechanism
Administration
Applicability
SE
62
How RB works?
TS suppressor protein
(when non-phosphorylated) sequester E2F
Blocks entry to S phase
63
How p53 works?
Phosphorylation of p53 leads to G1/S arrest
64
CA bladder
RR for smoking: _
RR for stopping smoking: _
3X
| 40%
65
Ca bladder
| M : F = ?
4 : 1
66
Describe lifecycle of schistosomiasis
Miracidia
Sporocyst
Cercariae
Adult
67
Name urine biomarkers for CA bladder
NMP22
BTA
Immuno-cyt
UroVysion
68
Efficacy of BLC in CA bladder
10% ARR for recurrence in low risk
69
Efficacy of NBI in CA bladder
20% ARR in recurrence (CROES)
70
What are von Hansemann cells and Michaelis-Gutmann bodies?
Large eosinophilic granular histiocytes
| Basophilic laminar inclusion bodies
71
CA bladder staging
| what is N2 , N3
>1 nodes in true pelvis
| Common iliac node
72
Name some characteristic genetic changes in low and high-risk NMIBC.
Low: loss of heterozygosity ch9, activating mutation FGFR3 ch4
High: p53, Rb, PTEN, ch9 deletion
73
what is gemcitabine?
cytosine analogue
triphosphate
elongating dna chain
inhibit synthesis
74
what is BCG failure
BCG intolerant
BCG relapse
BCG refractory
75
what does HYMN trial tell us?
RITE, MMC
| Better DFS in papillary-only disease
76
efficacy of pembro in BCG-failure NMIBC
CIS disease
| 41% CR
77
what is encoded by the gene carried by Nadofaragene?
IFNa-2b
78
Ca bladder
| __ had muscle invasion at presentation
57%
79
what is cisplatin?
alkylating agent
80
CA bladder
| pCR for neoadj chemo
~ 30%
81
CA bladder
| ___ of cN0 will have pN+
25%
82
CA bladder
| Indication of urethrectomy
2
83
CA bladder
| role of adjuvant immuno?
Nivolumab 1y
| Better DFS than placebo
84
CA bladder - risk of distant recurrences after RC
pT2
pT3
pT4
20%
40%
>50%
85
Met CA bladder
| Addition of pembro to cisplatin provide OS benefit: T / F
False
86
Role of avelumab in met CA bladder
Better OS as maintenance tx (over supportive care)
87
What is Amsterdam criteria?
```
3 relatives
1 + 2
2 successive
1 < 50y
FAP exc
```
88
UTUC staging
| N1 N2 N3
single < = 2cm
2 - 5cm / multiple
> 5cm
89
ODMIT-C: efficacy
ARR 11% of 1y recurrence
90
POUT trial
| Inclusion and efficacy
DFS HR 0.54
91
UTUC
| Medican eGFR decline after NU: __
18%
92
UTUC - antegrade instillation of BCG
| Regimen = ?
3 vials in 150ml NS
20cm above
1ml/min
for 2h
93
UTUC
| 5y-CSS for T3 , T3 with renal sinus fat invasion = ?
54%
| 25%
94
relaitonship of inverted papilloma and CA bladder
urothelial CA elsewhere
95
4 associations with adenoCA of bladder
urachal
bladder exstrophy
augmentation
cystitis glandularis
96
CA bladder
| what mutation is associated with plasmacytoid variant?
CDH-1 (E-cadherin) mutations
97
```
RCC
Molecular staining:
CC: _ ; _
Papillary: _
Chromophobe: _ ; _
```
CD10; CA9
Type 1: CK7
Hale's colloidal stain ; CK7
98
Black males / sickle cells + RCC =?
Renal medullary CA
99
Translocation-associated carcinoma:
| __ % of childhood RCC
30%
100
what is paraneoplastic syndrome?
systemic manifestation
| unrelated to local presence
101
```
VHL
Ch:
Gene:
Codes for:
Associations:
```
3p
VHL gene
VHL protein
102
```
HPRC
Ch
Gene
Codes for
Associations
```
7
MET
receptor
103
```
HLRCC
Ch
Gene
Codes for
Association
```
1
FH gene
FH
104
```
BHD
Ch
Gene
Codes for
Associations
```
17
BHD gene
Folliculin
Lung cyst, PTX, fibrofolliculoma
105
What subtype is similar to HLRCC?
| Associations
SDH-deficient cancer
| Phaeo / GIST
106
```
RCC staging
what is :
T3c
N1
N2
```
supra-diaphragm / invades wall
N1: regional LNs
NO N2
107
Role of pembro in localised RCC
Adjuvant tx for int/high risk: better DFS 9%
108
Metastatic RCC
__ % presents with mets
__ % are solitary
20%
| 1%
109
SE of TKI
HT (30%)
Diarrhea
Fatigue, hypoT
Hand foot syndrome
110
Survival benefit of cytoreductive nephrectomy
NO
111
RCC: 5y-CSS
T1
T2
T3
>90%
80%
T3a 50%
112
Prognostication for a locally recurrent RCC
| Factors = ?
> 5cm
Sarcomatoid
PSM
High ALP / LDH
113
IMDC for RCC criteria = ?
| Median OS for each group = ?
CBC Ca time Karnofsky
| 43 23 8 months
114
SRM
Chance of benign
< 1cm = ?
3 - 4 cm =?
46%
| 8%
115
SRM
| Chance of synchronous mets (i.e. on presentation)
< 2%
116
SRM
| Mean growth rate = ?
0. 28cm / year
| 0. 4cm/ year if confirmed RCC
117
PN for SRM:
PSM rate
Ipsilateral recurrence
2% (vs 0.4%)
| 1%
118
SRM
Lap vs. open PN:
PSM rate
Same (1%)
119
PN for SRM
| Risks of new CKD
GFR < 60: 20%
| GFR < 30: 17%
120
Mechanism of RFA
High freq alt current
ion agitation
frictional heating
121
Cryo for RCC : risks of =
Retreatment
Local progression
Met
1.3%
5.2%
1%
122
CA testis
Lifetime risk _
Incidence per 100,000 (young group) _
1 in 210
| ~ 15 (age dependent)
123
UDT for CA testis: RR = ?
Overall 3.2
Ipsilateral 6.3
Contralateral 1.7
124
CA testis
_ % has personal hx
_ % has FHx
5%
| 1.8%
125
CA testis
| Which confers stronger RR, wrt FHx : sibling vs. father-son?
Sibling (X-linked locus)
126
what is microlithiasis?
>= 5 non showing echogenic foci
<= 3mm
single sonogram
127
CA testis: raised tumor markers
Overall _
NSGCT _
Seminoma _
50%
90%
30%
128
Incidence of GCNIS
general population: 0.8%
| contralateral tumor: 5 - 10%
129
Testicular bx preservation in __
Bouin's solution
130
T 1/2 of
aFP
B HCG
7days
| 2 days
131
CA testis staging
T1
T2
N1 N2 N3 (ref UTUC)
limited to testis
LVI/epididymis/hilar/ext TA
2, 2-5, >5cm
132
Stage 1 seminoma
| __% has subclinical mets
20%
133
Findings of MRC TE 19
Oliver
| Relapse-free survival 96% @ 4y for high risk stage 1 seminoma undergoing adjuvant tx
134
Findings of MRC TE 18
20Gy
Less lethargy
Relapse rate 0.7% higher than 30Gy
(adjuvant for stage 1 high risk seminoma)
135
Result of SEMPET trial
NPV 96% for > 3cm residual retroperitoneal mass (sem post-tx)
136
what is bleomycin?
anti tumor agent
metallobleomycin complex
DNA breaks
137
Proportions of disease shown during RPLND for > 1cm residual mass post-chemo for NSGCT
10% residual
50% teratoma
40% necrosis
138
What testicular tumor is associated with Klinefelter?
Mediastinal GCT
139
what is BXO?
chronic inflam
| tears/cracks/hyperkeratotic
140
what is 5-FU
pyrimidine analogue
non compet inhibit thymidylate synthase
S phase arrest
141
what is imiquimod cream?
imidazoquinonin tetracyclicamine
Toll 7 receptor
activate immune cells , cytokine release
142
___% of CA penis has BXO
| ___% of CA penis has HPV
28%
| 60 - 80%
143
CA penis staging
T1b T2
N1 N2 N3
T1b = LVI/HG ; T2 = corpus spongiosum
| 1-2 ; bilateral or >=3; ECE or pelvic
144
```
CA testis (cN0)
The only group of patients who do not need nodal staging
```
T1a G1
145
CA penis
| Indication for PLND
> 1 inguinal LN
| ECE
146
features of benign penile ulcers
syphilis
chancroid
lymphogranuloma venereum
ulcer , LN: painful vs. painless
syphilis: painless
chancroid: painful
LG: painless ulcer, painful nodes
147
Any role for neoadj chemo for T3-T4 CA urethra?
yes
| cisplatin
148
CA urethra
| pN+ rate: __ for cN0 disease
9% only
149
what is:
Barbagli procedure
Asopa urethroplasty
Kulkarni's urethroplasty
Dorsal stricturotomy + onlay BMG
inlay BMG
One sided dissection , dorsal stricturotomy + onlay BMG
150
what is Orandi flap?
stricturotomy + penile skin flap for proximal penile urethral stricture
151
what is radiation?
| what is ionizing radiation?
emission of energy in wave / particles
| high enough energy to remove electron
152
what are the 4 Rs of radiotherapy?
normal tissues : repopulate, repair
| tumor : reoxygenate, reassortment
153
what is RPF?
proliferation of fibro-inflammatory tissue in retroperitoneum
154
what drugs are associated with RPF?
B-blocker, methyldopa, phenacetin, bromocriptine, hydralazine.....
