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A 62-year-old man with a long history of cigaret - highsky
#1
A 62-year-old man with a long history of cigarette smoking comes to the office with a 3-month history of painless gross hematuria. Physical examination is unremarkable. Urologic evaluation, including cystoscopy, reveals a medium-sized bladder tumor. You recommend a surgeon to the patient and a transurethral resection is performed. The pathology shows high-grade transitional cell carcinoma invading the muscularis propria. A metastatic workup is negative and the patient is counseled regarding radical cystectomy and urinary diversion. A radical cystectomy, pelvic lymph node dissection, and ileal conduit are performed successfully. The surgical margins and lymph nodes are all negative. An 18-month follow-up CT scan of the pelvis reveals a 4-cm heterogeneous, contrast enhancing mass. A biopsy shows a high-grade transitional cell carcinoma. The patient is referred to an oncologist who suggests chemotherapy using a platinum-based regimen. He comes back to your office and tells you that he has heard so many "horror stories" about chemotherapy and that he is concerned about the toxic side effects of the recommended platinum-based regimen. He should be told that this regimen significantly increases his risk of developing

A. cardiac toxicity
B. myelosuppression
C. nephrotoxicity
D. neurotoxicity
E. pulmonary toxicity
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#2
ans c?
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#3
i think its b
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#4
c.nephrotoxicity
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#5
CCC
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#6
C.
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#7
The correct answer is C. The mainstay of treatment for advanced, metastatic, or recurrent urothelial carcinoma involves platinum based chemotherapy regimens, usually in combination regimens. The most commonly used regimen is MVAC using methotrexate, vinblastine, adriamycin, and cisplatinum. Unfortunately, toxicity often limits the usefulness of these regimens. The toxicity most often associated with platinum is nephrotoxicity. Acute tubular necrosis develops in approximately 25% of patients, and is often the dose-limiting factor. This toxicity can be prevented by keeping patients well hydrated and using diuretics during therapy.

Cardiac toxicity (choice A) is associated with doxorubicin (adriamycin). A cumulative dose-related cardiomyopathy results from doxorubicin treatment and can be fatal.

Myelosuppression (choice B) is an adverse affect of many chemotherapeutic agents. Most noteworthy are methotrexate, vinblastine, and doxorubicin.

Neurotoxicity (choice D) is associated with the vinca alkaloids, especially vincristine. Vincristine can produce a dose-related mixed motor-sensory and autonomic neuropathy.

Pulmonary toxicity (choice E) is associated with bleomycin. Pulmonary fibrosis can result from bleomycin and pulmonary function tests may be necessary in these patients.

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