Ovarian and Bladder Cancer

Question 1

What are some important predisposing factors for epithelial ovarian Carcinoma?

Answer 1

Family Hx

BRCA 1/2

Question 2

Your patient is over 35 years old and has epithelial ovarian carcinoma. What is a good treatment method?

Answer 2

Prophylactic Oophorectomy

Question 3

What factor in the blood stream can be used to monitor epithelial ovarian carcinoma?

Answer 3

CA-125

Question 4

What is the staging method for epithelial Ovarian Carcinoma?

Answer 4

Stage 1 = only in the ovaries
Stage 2 = Ovaries and Pelvis
Stage 3 = Ovaries, Pelvis, and lymph nodes
Stage 4 = mets to bone/lung/liver (pleural effusion)

Question 5

What is the typical chemotherapeutic treatment for epithelial ovarian carcinoma?

Answer 5

High volume intra-peritoneal cisplatin instillation.

Question 6

What is the Chemotherapeutic regimen for Stage 1&2 epithelial ovarian carcinoma?

Answer 6

Carbo/Cisplatin IP and Cyclophosphamide and/or doxorubicin IV

Question 7

What is the chemotherapeutic regimen for Stage 3&4 epithelial Ovarian Carcinoma?

Answer 7

Carboplatin/cisplatin IP and Paclitaxel

Question 8

What is the presenting symptom of bladder carcinoma most likely to be?

Answer 8

Painless hematuria

Question 9

What is the treatment for Bladder carcinoma (generally speaking)?

Answer 9

Transurethral resection

Chemo is put in the bladder

Question 10

What is the MOA of Carboplatin/Cisplatin?

Answer 10

Creates DNA intrastrand crosslinks

Question 11

What are the adverse effects associated with Carboplatin?

Answer 11

Allergic rxn
Dose related myelosuppression, anemia
elevated hepatic enzymes
Elevated BUN/Cr

Question 12

What are the adverse effects associated with Cisplatin?

Answer 12

Allergic rxn
Dose related NEPHROTOXICITY
Ototoxicity

Question 13

What is the MOA of Cyclophosphamide?

Answer 13

cyclophosphamide alkylates DNA.

it is also a prodrug

Question 14

What are the adverse effects associated with cyclophosphamide?

Answer 14

Hemorrhagic cystitis (mesna)
Anemia
Amenorrhea/infertility
Pulmonary fibrosis

Question 15

What is the MOA of Doxorubicin?

Answer 15

Intercalates within DNA
Generates free radicals
inhibits Topo 2

Question 16

What are the adverse effects associated with Doxorubicin?

Answer 16

CARDIOTOXICITY (dose limiting)
Liver disease
Extravasational necrosis

Question 17

What should you give with doxorubicin to help with the cardiotoxicity?

Answer 17

Dexrazoxone

Question 18

What is the MOA of Paclitaxel?

Answer 18

Paclitaxel is a microtubule stabilizer

Question 19

What adverse effects are associated with paclitaxel?

Answer 19

Hypersensitivity
Peripheral neuropathy
Arthralgia/myalgia

Question 20

What is the MOA of BCG?

Answer 20

Binds to urothelium and activates APCs thus inducing immune activation. lasts for months, is used post TUR.

Question 21

What is the MOA of Mitomycin C?

Answer 21

Mono/bi - functional alkylator

Question 22

What adverse effects are associated with Mitomycin C?

Answer 22

Pneumonitis
pancytopenia
Chemical cystitis
Dermatitis (when urine contacts skin)

Question 23

What is the MOA of Thiotepa?

Answer 23

DNA alkylation via aziridine groups and intrastrand cross-linkage.

Question 24

What adverse effects are assoicated with Thiotepa?

Answer 24

Pancytopenia
Dysuria
urine retention 
Chemical cystitis
Renal dysfunction