CANCERUL RENAL

TRATAMENT:
I) Operabil :
- nefrectomie+limfadenectomie
- daca MR+ -> radioterapie
II) Avansate loco-reg + metastatice:
- imunoterapie
interferon RR=15-20%, IL 2, RR = 16-33%, vaccin RR=25%)
- trat. moleculare tintite
- Bevacizumab = anti VEGFR
- Cabozantinib
- Sunitinib = anti VE, PD-GFR, ras
- Sorafenib = anti VE, PD- GFR
- Axitinib
- Temsirolimus = inh m TOR
- Everolimus =inh m TOR
LINIA 1:
a) Prognostic bun, intermediar
- IFN + Bevacizumab
- Cabozantinib
- Sunitinib
- Pazopanib
b) Prognostic prost
- Temsirolimus
- Sunitinib
- Pazopanib
LINIA 2
a) citokine in linia 1
- sorafenib, pazopanib, and, axitinib, sunitinib
b) anti VEGF in linia 1
- Everolimus + Levantinib, Axitinib, Nivolumab, Cabozantinib, Sorafenib (optiune)
• Nivolumab – anti-PD 1
• Cabozantinib
• Linia 3
LINIA 3
a) 2 TKI s anterior:
- Nivolumab
b) 1 TKIs si Nivolumab anterior:
- Cabozantinib, Everolimis, Axitinib
c) Anti VEGF si mTOR inhibitor anterior:
- Sorafenib
- Nivolumab
- cabozantinib
CANCERUL VEZICII URINARE
TRATAMENT:
Tumori superficiale:
- TaG1: TUR extensiv maximal, apoi control la 4 luni (citologie, cistoscopic)
Restul tu superficiale: idem + imunoterapie i vezicala (BCG)+ chimioterapie intravezicala
(Doxorubicina)relivcat tu post chimio, imuno= cistectomie totala
TUMORI INFILTRATIVE:
T1G1, G2: TUR maximal + BCG intravezical
T1G3 + CIS asociat = cistectomie radicala cu neovezica ortotopica, ureterostomie cutanata
sau ureterosigmiodostomie
T2 = cistectomie radicala
Alternative
- TUR max : T2a, fara CIS asociat, nonpalpabila, fara hidronefroza
- Cistectomie partiala + curieterapie
- TUR max + RCT conc
- RTE exclusiv
- T3 - RTE neoadj +cistectomie radicala + CT adj daca pT3, pT4, N+
- T4 - idem T3 sau RTE pal
- N+/M+ : CT pal (Gemzar+Cisplatin, Taxani + Cisplatin)

CANCERUL DE PROSTATA
TRATAMENT:
Std I, II - CH radicala
- brahiterapie exclusiva pt tu mici, v↑, tare med care afecteaza speranta de viata
- RTE +/- brahiterapie+/-LHRH agonisti (Zoladex vs orhiectomie)
Std III (avansate loco-regional) RTE +/- brahiterapie +HT neoadj ( antiandrogeni Flutamida)
Std metastatice: hormonosensibili
ADT: HT (antiandrogeni, LHRH), RTE pal
• Hormono rezistenti (rezistenti la castrare):
• - CS
• - Abiraterone: crește OS
- AE: hipokalaemia, HTA, edeme, AE cardiace
- Enzalutamide crește OS
- AE: fatigabilitate/astenie and HTA.
• - chimioterapie: Taxotere
• - Radium -223
CANCERUL TESTICULAR
Tratament:
Chirurgia: orhiectomie radicama cu obord inghinal
- disectie in retroperitoneu cand b. reziduala post chimioterapie
Radioterapie: 20-30 G, seminoame
Chimioterapie bazata pe cisplatin (etopozid + cis +/- bleomicina)
Rezultata:
Std I: 95%
Std II: 74-92%
Std III: 61-88%