05a: Testicular/Prostate Flashcards
Cancers in the scrotum can arise from various tissues. List the different categories of tumors.
- Germ cell tumors (seminoma, nonseminoma)
- Sex cord-stromal
- Paratesticular
T/F: Testicular cancer is the most common cancer in the young adult/middle aged man.
True (20-34 yo) - but still a very rare cancer
T/F: Testicular cancer cannot occur before puberty
False
T/F: Testicular cancer is highly treatable with quite simple Rx.
False - highly curable, but complex Rx, need multi-disciplinary team
List some RFs for testicular cancer:
- Past Hx of testicular cancer
- FHx
- Kleinfelter’s or Down’s
- HIV/AIDS
- Heavy marijuana use
T/F: Testicular cancer most common in white males.
True
Most common initial presentation/Sx for testicular cancer:
Painless scrotal mass
List some Sx of advanced testicular cancer that patients may present with:
- Back pain (enlarged nodes)
- Gynecomastia (high hCG)
- Infertility
- Sx of metastasis (bone pain, kidney failure, neuro/liver issues, etc.)
List the lab markers checked for suspected testicular germ cell tumors
- LDH
- AFP
- Beta HCG
If testicular cancer is suspected based on lab work, what’s the next step?
Urgent scrotal ultrasound
Testicular cancers spread in (orderly/disorderly) pattern.
Orderly - 95% start in retroperitoneum
Testicular cancer imaging: urgent (X) used to assess scrotal mass. Which other imaging modalities would you order?
X = scrotal ultrasound
Abdominal/pelvic CT with contrast (assess retroperitoneum for cancer spread)
Patient with suspicious L testicular mass gets abdominal CT to assess for metastasis. Where is the first place you’d expect to find the mass if this was cancer?
L Para-aortic space (between aorta and kidney) - since L testicular vein drains into L renal artery
Patient with suspicious R testicular mass gets abdominal CT to assess for metastasis. Where is the first place you’d expect to find the mass if this was cancer?
Inter-aortocaval space (under renal vein) - since R testicular vein drains into IVC directly
Testicular cancer: what’s the step after cancer is confirmed by imaging?
Urgent urology consult
T/F: After imaging, testicular cancer is definitively diagnosed by biopsy.
False! NO scrotal biopsy done and inguinal approach for biopsy is rarely performed
Testicular cancer: (X) procedure is both diagnostic and therapeutic for these patients.
X = orchiectomy (radical removal of entire testicle via inguinal excision)
Seminoma: which lab markers are elevated? Star the one that rises to greatest extent.
- LDH*
- HCG
(don’t make AFP)
Non-seminoma: which lab markers are elevated? Star the one that rises to greatest extent.
- LDH
- HCG
- AFP
Can be any combo, with varying amounts (depending on specific type of carcinoma)
Embryonal carcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
Non-seminoma
HCG (histo looks like that of embryo)
Yolk sac carcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
Non-seminoma
AFP (histo looks like that of yolk sac)
Choriocarcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
Non-seminoma
HCG (histo looks like that of placenta)
T/F: Teratoma is a seminoma and responds best to chemo/radiation dual therapy.
False - it’s a non-seminoma that does NOT respond to chemo/radiation (requires surgical resection)
(X) non-seminoma raises LDH, but not HCG or AFP.
X = teratoma
Testicular cancer: what does stage 1S mean?
Imaging normal, but tumor markers elevated after orchiectomy
The worst category of stratification for testicular cancer is (seminoma/non-seminoma) in Stage (X) and (Y) risk stratification group. What’s the cure rate?
Non-seminoma
X = III
Y = poor risk
74%
T/F: In general, loss of one testicle does not negatively impact fertility
True - may actually improve function of contralateral testicle
Retroperitoneal Lymph Node Dissection (RPLND) is a procedure only done in (X) testicular cancer patients. There is (rare) risk of which complication?
X = non-seminoma
Retrograde ejaculation
Testicular cancer: which tumors get radiation?
Only seminomas (exquisitely sensitive to radiation)
Multidrug chemo regimen for testicular cancer includes which drugs?
BEP or EP
- Bleomycin
- Etoposide
- cisPlatin
Prostate zone where cancers most commonly arise.
Peripheral (posterior)
Prostate zone where BPH most commonly arises.
Transitional zone
Prostate cancer: neoplastic tissue has (X) texture
X = gritty
List the two general forms of prostate adenocarcinoma:
- Lethal form (with local spread and metastasis)
2. “Incidental” latent form
Gleason Grading System: It is (X) characteristics that forms the basis for grading, to assess the prognosis of (Y) cancer.
X = degree of gland formation Y = prostate adenocarcinoma
