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Urology > B/10. Testicular tumors > Flashcards

B/10. Testicular tumors Flashcards

1
Q

Epidemiology of testicular tumors

A
  • Cancer of young men (age at presentation usually 18-35 years)
  • Caucasians > African-American
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2
Q

Cancer of young men

A

testicular tumors
18-35 years)

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3
Q

Risk factors for testicular tumors

A
  • Cryptorchidism (abdominal cryptorchid testis > inguinal cryptorchid testis) : strongest risk factor
  • Family history
  • Klinefelter syndrome
  • Tumor of contralateral testis
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4
Q

what can reduce the risk of germ cell tumors and improves the ability to save the testis

A

Early orchiopexy

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5
Q

abdominal cryptorchid testis that cannot be brought into the scrotum should be

A

removed.

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6
Q

Clinical findings in testicular tumors

A
  • Painless testicular mass in young men is pathognomonic for a testicular malignancy.
  • The mass does not transilluminate (differential : hydrocele)
  • More commonly, patients present with testicular discomfort or swelling suggestive of
    epididymitis and/or orchitis.
    In this circumstance, a trial of antibiotics is reasonable
  • However, if symptoms persist or a residual abnormality remains: testicular US is indicated
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7
Q

differential between hydrocele and testicular tumor

A

tumor mass does not transilluminate

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8
Q

Testicular tumors diagnostic

A
  • However, if symptoms persist or a residual abnormality remains: testicular US is indicated
  • If a testicular mass is detected, a radical inguinal orchiectomy should be performed
  • Biopsy is contraindicated!
  • serum level of alpha-fetoprotein (AFP), hCG, and LDH should be measured
  • CT scan of the chest, abdomen, and pelvis is indicated after orchiectomy
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9
Q

can u take biopsy of testicular lesion?

A

Biopsy contraindicated!!!!!

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10
Q

labs to be checked in suspicioun of testicular tumor

A
  • serum level of alpha-fetoprotein (AFP),
  • hCG, and
  • LDH should be measured
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11
Q

When is CT indicated in testicular tumors?

A

CT scan of the chest, abdomen, and pelvis is indicated
after orchiectomy

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12
Q

If a testicular mass is detected what should be performed?

A

radical inguinal orchiectomy

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13
Q

Signs and symptoms due to metastatic testicular cancer

A
  • back pain from retroperitoneal metastases,
  • dyspnea due to lung metastases (less common), and
  • gynecomastia due to tumors producing hCG.
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14
Q

Testicular mass in mass in male above or equal to 50 years should be regarded as

A

lymphoma until proven otherwise

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15
Q

pathology of testicular tumors

A
  • Germ cell tumors (>95%):
    *Seminoma
    *Non-seminoma: Endodermal sinus (yolk sac) tumor, Choriocarcinoma, Embryonal carcinoma, Teratoma
  • Non-germ cell tumors ( < 5%)
    *Sertoli cell tumor : Mostly benign
    *Leydig cell tumor :Mostly benign
    *Testicular lymphoma
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16
Q

Most common testicular tumor

A

Seminoma

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17
Q

Seminoma prognosis

A
    • Most common testicular tumor (50%)
  • Tends to metastasize late, good prognosis
18
Q

Non-seminoma

A
  • Endodermal sinus (yolk sac) tumor: Tumor secretes AFP, Aggressive
  • Choriocarcinoma: tumor secretes beta-hCG, May present with gynecomastia and symptoms of hyperthyroidism
  • Embryonal carcinoma : Painful, hemorrhagic mass with necrosis
  • Teratoma: Usually malignant (compared with female teratoma)

learn the names onlys in this flashcard

19
Q

Endodermal sinus
(yolk sac) tumor

is it good or aggressive ?

A

Tumor secretes AFP
- Aggressive Non-seminoma

non seminoma germ cell tumor

20
Q

Choriocarcinoma

what does it present with

A
  • tumor secretes beta-hCG
  • May present with gynecomastia and
    symptoms of hyperthyroidism

non seminoma germ cell tumor

21
Q

Embryonal carcinoma feature

A

Painful, hemorrhagic mass with necrosis

non seminoma germ cell tumor

22
Q

Teratoma
is it malignant or benign?

A

Usually malignant (compared with female
teratoma)

non seminoma germ cell tumor

23
Q

Non-germ
cell tumors

A

(< 5%)
* Sertoli cell tumor Mostly benign
* Leydig cell tumor Mostly benign
* Testicular lymphoma
-Most common testicular cancer in older men
-Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)

24
Q

-Most common testicular cancer in older men

A

Testicular lymphoma

-Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)

25
Q

is testicular lymphoma usually a primary testicular disease?

A

Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)

26
Q

Germ cell
tumors
(>95%)

A
  • Seminoma
  • Non-seminoma:
    *Endodermal sinus (yolk sac) tumor
    *Choriocarcinoma
    *Embryonal carcinoma
    *Teratoma
27
Q

Staging of testicular tumor is based on

A

Based on the American Joint Committee on Cancer (AJCC) groups, which
combines TNM stage and
serum tumor marker levels

28
Q

Staging of testicular tumor

A

T1 Disease is limited to the testis, epididymis, no LN involvement

T2 Disease is limited to the retroperitoneal (regional) LNs (paraaortic nodes)

T2a Affected LN < 2 cm
T2b Affected LN 2-5 cm
T2c Affected LN > 5 cm

T3 Disease outside the retroperitoneum, involving supradiaphragmatic nodal sites or viscera
(metastases); with moderately to highly elevated tumor markers

29
Q

Treatment of testicular tumors

A
  • Prior to surgery: sperm cryopreservation
  • Radical inguinal orchiectomy
  • Adjuvant radiotherapy and chemotherapy
30
Q

adjuvant Treatment of seminomas
Following radical inguinal orchiectomy
T1, T2, T3

A
  • T1:
    *active surveillance OR
    *chemotherapy (carboplatin) OR
    *Radiation therapy of regional LNs
  • T2:
    *Radiation therapy
    *CHEMO: BEP1 (bleomycin, etoposide, and cisplatin) or EP ( etoposide, cisplatin)
  • T3: chemo (full dose, not adjuvant) +/- resection of any residual disease focus
31
Q

active surveillance in testicular tumors

A

Regular follow-up appointments with physical examination,
chest x-ray
, and abdominopelvic CT scan.

32
Q

Treatment of non-seminoma testicular tumor

A
  • radical inguinal orchiectomy
  • adjuvant treatment (after surgery)
33
Q

adjuvant treatment of non-seminoma stage 1

A
  • Active surveillance or
  • RPLND3 ± cisplatin-based chemotherapy
  • Chemotherapy: BEP
34
Q

adjuvant treatment of non-seminoma stage 2

A
  • In patients with normal post-orchiectomy tumor markers: RPLND3 ± cisplatin-based chemotherapy
  • In patients with elevated post-orchiectomy tumor markers: chemotherapy with BEP1or EP2
35
Q

adjuvant treatment of non-seminoma stage 3

A

Chemotherapy (depending on prognosis):
BEP1 or EP2 followed by evaluation of any residual disease that may require resection

36
Q

RPLND (retroperitoneal lymph node dissection) what is it

A

the standard procedure for removal of the regional lymph nodes of the testis (retroperitoneal nodes).

  • removes the LNs draining the primary site and the nodal groups adjacent to the primary landing zone.
  • The standard (modified bilateral) RPLND removes all node-bearing tissue down to the bifurcation of the great vessels, including the ipsilateral iliac nodes.
  • The major long-term effect of this operation is retrograde ejaculation with resultant infertility.

Nervesparing RPLND can preserve anterograde ejaculation in 90% of patients

37
Q

The major long-term effect of RPLND operation

A

is retrograde ejaculation with resultant infertility.

Nervesparing RPLND can preserve anterograde ejaculation in 90% of patients

38
Q

Chemotherapy used for testicular tumors

A
  • 1st line: bleomycin, etoposide, cisplatin
  • 2nd line: vinblastine, ifosfamide
39
Q

short term side effects of chemotherapy for testicular tumors

A
  • alopecia
  • myelosupression
  • neutropenia
  • sepsis
  • severe N/V
40
Q

Longterm SE of Cisplatin

A
  • nephrotoxicity,
  • ototoxicity,
  • peripheral neuropathy,
  • infertility (germ cell damage
41
Q

Long- term SE of bleomycin

A

pulmonary fibrosis

42
Q

what should be recommended to all patients before treatment of testicular tumor?

A

Semen analysis
and
cryopreservation

Urology (30 decks)

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