Bouncy Flashcards
Epidemiology of testicular cancer?
Age- Most common malignancy in 20 – 40yo
Seminoma 25 – 40yo
Teratoma 20‐35yo
(NHL in 50yo+)
Risk factors of testicular cancer?
- testicular maldescent/ cryptorchidism
- Early onset of puberty / sexual activity
- Reduced sperm‐count/ low fertility
Risk factors of testicular cancer? (history)
- Pre‐natal oestrogen exposure
- maternal smoking
- testicular trauma
- vasectomy
- mumps orchitis (VIRUS)
Risk factors of testicular cancer? (genetic)
familial correlation
Some rare familial syndromes
Short arm isochromosome of Chromosome 12
Risk factors of testicular cancer? (ethnic)
Caucasian vs African Americans 5:1
Risk factors of testicular cancer? (Lifestyle)
lack of exercise/ sedentary lifestyle
What are the primary presenting signs and symptoms?
- Palpable (solid) lump in testicle
- pain in testicle
- Dull ache or sharp pain, may come and go
- infertility
What are the secondary signs and symptoms?
- Back pain
- Abdominal pain
- Loin pain
- Haemoptysis from lung mets
- Neck lymphadenopathy
- Gynecomastia
- Loss of appetite, weight loss
What is the histology of cancer?
- Germ‐cell origin
- Seminoma
- Teratoma
- combination
(GSTC)
Which staging systems are used for testicular cancer?
Numerous systems in use
e.g. Royal Marsden staging
IGCCC prognostic grouping
Patters of spread for testicular cancer? (germ cell tumours)
Local—>Epididymis and spermatic cord
Lymphatic spread:Upper para‐aortic nodes, pelvic, mediastinal, supraclavicular nodes,
Then either:
Up‐ Mediastinal and supraclavicular nodes
Down‐ lower para‐aortics and pelvic nodes
Distant–> pineal regions and lung
Clinical management?
Surgery
Radiotherapy
Chemotherapy
Surveillance
Surgery options?
- Orchiectomy (Definitive treatment)
- Spermatic cord removal as high as possible (Via inguinal incision)
- Nodal dissemination (Late stage & non germ‐cellTeratomas)
- extended retroperitoneal lymphadenectomy (teratomas)
RT options?
- Germ‐cell, Stages I‐IIB: Post‐op RT with Paraaortic +/‐ Ipsilateral Pelvic.
- Germ‐cell, Stages beyond IIB:Post‐op Chemo
-Non germ‐cell: Post‐op Chemo
[No RT except for mets]
Chemo options?
Germ‐cell tumours: Gold standard chemo is BEP
(bleomycin, etoposide, cisplatin)
3 cycles (Alt EP, 4 cycles)
NHL: CHOP (6 cycles)
(cyclophosphamide, doxorubicin, vincristine, prednisone)
Chemo complications? (Acute and long term)
Complications
Acute: gastro disturbance, nephrotoxicity, pulmonary fibrosis
Long term: tinnitus/ hearing loss, arterial, hypertension, peripheral neuropathy, infertility
What are the volumes and doses for EBRT?
Paraaortic +/‐ Ipsilateral Pelvic Nodes:
20Gy–30Gy in 10‐15#
Field Placement and technique?
- Opposed pair, Ant & Post
- Possibly shield kidney
- Possible ‘dogleg’ to include pelvic nodes
- (Possible external shields for gonad)
Imaging protocol? (inf and sup levels)
Scan: Sup – mid thoracic
Inf – 5cm+ below scrotum
Ideal set up for testicular patients?
-supine, arms up, clothing removed, headrest, knee bolster, footstocks,
Where would be consider placing levelling tattoos?
one pelvic and one abdo.
May also require equatorial tattoos
EBRT acute side effects and care management?
- Nausea: Serotonin blocker ondansetron (Zofran)
- Diarrhoea: Immodium and dietary advice
- Tiredness: Get some rest
- Immunosuppression: Regular blood tests
EBRT late side effects and care management?
- Decreases in sperm‐count (2‐3yrs only): Pre-cautionary sperm banking
- Psychosocial issues for paediatrics
- Dyspepsia, occasional peptic ulcer
- Secondary cancers (~12% over 30y)
