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RDS Test 3 > B8.051 Germ Cell Tumors > Flashcards

B8.051 Germ Cell Tumors Flashcards

1
Q

epidemiology of testicular cancer

A

males between age 15-45 years
<1% of all cancers in men
highest risk in scandinavia and switzerland, lowest in asia and africa

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2
Q

risk factor for testicular cancers

A 
cryptorchidism: 3-5x
klinefelter's syndrome (XXY)
infertility: 1-2x
family history: sibling history is 8-10x
prior history of testicular cancer increases risk of contralateral tumor
HIV
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3
Q

lymphatic drainage of testicle region

A

scrotal skin drains to superficial inguinal nodes

testis drain to lumbar lymphatic nodes (para aortic)

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4
Q

clinical presentation of testicular cancer

A

painless testicular swelling (60-70% of patients)
heavy sensation or testicular discomfort (30%)
acute pain is rare

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5
Q

symptoms or signs of metastatic testicular disease

A

10% of patients

  • nausea, vomiting, abdominal pain (retroperitoneal LN)
  • cough, dyspnea (lung mets)
  • neck mass (supraclavicular LN)
  • bony pain (osseous metastases) +/- radiculopathy
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6
Q

ddx of tender testicular mass

A

torsion
orchitis
epididymitis

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7
Q

ddx of nontender testicular mass

A

hydocele: trans illumination +
varicocele: ‘bag of worms’ on palpation
inguinal hernia: indirect, extends to inguinal ring
spermatocele
malignancy: testicular cancer, lymphomas

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8
Q

common course of testicular cancer

A

painless testicular mass
course antibiotics for 2-4 weeks
testicular US
radical inguinal orchiectomy

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9
Q

imaging studies for evaluating testicular cancer

A

testicular US
-extremely sensitive in evaluating testicular masses (nearly 100%)
CT scan (chest, abdomen, pelvis)
-to determine adenopathy and visceral involvement

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10
Q

tumor markers of testicular cancer

A

AFP
B-HCG
LDH

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11
Q

AFP in testicular cancer

A

synthesized by fetal yolk sac, liver, and intestines
half life of 5-7 days
elevated in yolk sac tumors and teratomas

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12
Q

false elevations of AFP

A

hepatic dysfunction

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13
Q

B-HCG in testicular cancer

A

secreted by syncitiotrophoblastic cells
half life 1-1.5 days
elevated in seminomas and choriocarcinomas

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14
Q

false elevations of B-HCG

A

tumor lysis after chemo
treatment related hypogonadism
marijuana use
presence of heterophile antibodies

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15
Q

LDH in testicular cancer

A

nonspecific tumor marker
marker of overall tumor burden, growth, and overall proliferation
elevated in 60-80% of patients with advanced disease

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16
Q

use of tumor markers in testicular cancer

A

tumor markers are prognostic, help examine disease burden

also help to monitor treatment, should normalize over time

17
Q

cytogenetic changes in testicular cancer

A

isochromosome 12p is frequently seen with testicular germ cell tumors
diagnosed by karyotyping or FISH
may help determine whether it is a GCT for tumor of unknown primary

18
Q

what is a radical orchiectomy

A

radical inguinal orchiectomy with high ligation of the spermatic cord at the level of internal ring

19
Q

function of radical orchiectomy

A

establishes primary histo-pathologic diagnosis
local tumor control (testis/scrotal sac considered as sanctum for tumors)
AVOID SCROTAL INCISION OR BIOPSY

20
Q

subtypes of testicular cancer

A 
seminoma
non-seminoma
-seminona
-embryonal cell carcinoma
-yolk sac tumor
-choriocarcinoma
-teratoma
21
Q

extragonadal GCT

A

rare, 10% of GCT
commonly occur in the mediastinum and retroperitoneum
pineal gland
**treated similarly to testicular tumors

22
Q

tumors in those age 0-5

A

teratome - benign

yolk sac tumor - malignant

23
Q

tumors in those age 15-45

A

seminoma or non-seminoma

typically malignant

24
Q

tumors in those age >50

A

spermatocytic seminoma - usually benign

25
Q

characterize spermatocytic seminoma

A

usually benign
contained within testicle
perform orchiectomy and follow over time
not a big risk of mets

26
Q

factors used in risk stratification of GCTs

A

seminoma vs non-seminoma
extent of disease
presence of non-pulmonary visceral disease
elevated tumor markers post orchiectomy: B-HCG, AFP

27
Q

risk classification

A

good
intermediate
poor

28
Q

what is unusual about the risk stratification of seminomas

A

no poor risk group, only good and intermediate

respond well to treatment

29
Q

treatment modalities for GCT

A

active surveillance (if markers normalize post-orchiectomy)
chemotherapy
retro-peritoneal lymph node dissection
radiation therapy

30
Q

chemo for testicular cancer

A

usually cisplatin based combo therapy

31
Q

overall response to treatment in testicular cancer

A

highest response and cure rates of all solid malignancies
response rate for stage 1 and 2 are 98-99%
response rate for stage 3 is 90%
response rate for salvage therapies is 60-70%

32
Q

post treatment complications

A 
bleomycin related pulm complications
renal toxicity
cardio toxicity
infertility
hematologic toxicity
bone loss
secondary malignancy
33
Q

secondary malignancy in testicular cancer

A

most common cause of death in survivors

1.9% for 10 years, 1.7% for 35 years

34
Q

growing teratoma suyndrome

A

enlarging tumor with normalization of tumor markers post treatment
teratomas are resistant to chemo and radiation

35
Q

cure for growing teratomas

A

surgical resection is the only curative modality

36
Q

clinical pearls regarding testicular cancer

A
  1. any testicular mass is an indication for inguinal orchiectomy
  2. testicular cancer spreads to retroperitoneal LN
  3. if AFP is elevated, patient has a non-seminoma
  4. surgery only treatment for teratoma
  5. late recurrences can occur, so follow for a long period of time
37
Q

survivorship of testicular cancer

A

majority survive (90%)

  • late relapse > 2 years after remission
  • metabolic syndrome
  • cardiovascular mortality
  • hypogonadism, infertility
  • psychosocial problems
  • fatige
  • osteopenia and osteoporosis
  • risk of secondary malignancies

RDS Test 3 (15 decks)

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