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Pete 3 > Bouncy > Flashcards

Bouncy Flashcards

1
Q

Epidemiology of testicular cancer?

A

Age- Most common malignancy in 20 – 40yo
Seminoma 25 – 40yo
Teratoma 20‐35yo
(NHL in 50yo+)

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2
Q

Risk factors of testicular cancer?

A
  • testicular maldescent/ cryptorchidism
  • Early onset of puberty / sexual activity
  • Reduced sperm‐count/ low fertility
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3
Q

Risk factors of testicular cancer? (history)

A
  • Pre‐natal oestrogen exposure
  • maternal smoking
  • testicular trauma
  • vasectomy
  • mumps orchitis (VIRUS)
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4
Q

Risk factors of testicular cancer? (genetic)

A

familial correlation
Some rare familial syndromes
Short arm isochromosome of Chromosome 12

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5
Q

Risk factors of testicular cancer? (ethnic)

A

Caucasian vs African Americans 5:1

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6
Q

Risk factors of testicular cancer? (Lifestyle)

A

lack of exercise/ sedentary lifestyle

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7
Q

What are the primary presenting signs and symptoms?

A
  • Palpable (solid) lump in testicle
  • pain in testicle
  • Dull ache or sharp pain, may come and go
  • infertility
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8
Q

What are the secondary signs and symptoms?

A
  • Back pain
  • Abdominal pain
  • Loin pain
  • Haemoptysis from lung mets
  • Neck lymphadenopathy
  • Gynecomastia
  • Loss of appetite, weight loss
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9
Q

What is the histology of cancer?

A
  • Germ‐cell origin
  • Seminoma
  • Teratoma
  • combination

(GSTC)

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10
Q

Which staging systems are used for testicular cancer?

A

Numerous systems in use
e.g. Royal Marsden staging
IGCCC prognostic grouping

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11
Q

Patters of spread for testicular cancer? (germ cell tumours)

A

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

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12
Q

Clinical management?

A

Surgery
Radiotherapy
Chemotherapy
Surveillance

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13
Q

Surgery options?

A
  • Orchiectomy (Definitive treatment)
  • Spermatic cord removal as high as possible (Via inguinal incision)
  • Nodal dissemination (Late stage & non germ‐cellTeratomas)
  • extended retroperitoneal lymphadenectomy (teratomas)
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14
Q

RT options?

A
  • 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]

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15
Q

Chemo options?

A

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)

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16
Q

Chemo complications? (Acute and long term)

A

Complications

Acute: gastro disturbance, nephrotoxicity, pulmonary fibrosis

Long term: tinnitus/ hearing loss, arterial, hypertension, peripheral neuropathy, infertility

17
Q

What are the volumes and doses for EBRT?

A

Paraaortic +/‐ Ipsilateral Pelvic Nodes:

20Gy–30Gy in 10‐15#

18
Q

Field Placement and technique?

A
  • Opposed pair, Ant & Post
  • Possibly shield kidney
  • Possible ‘dogleg’ to include pelvic nodes
  • (Possible external shields for gonad)
19
Q

Imaging protocol? (inf and sup levels)

A

Scan: Sup – mid thoracic

Inf – 5cm+ below scrotum

20
Q

Ideal set up for testicular patients?

A

-supine, arms up, clothing removed, headrest, knee bolster, footstocks,

21
Q

Where would be consider placing levelling tattoos?

A

one pelvic and one abdo.

May also require equatorial tattoos

22
Q

EBRT acute side effects and care management?

A
  • Nausea: Serotonin blocker ondansetron (Zofran)
  • Diarrhoea: Immodium and dietary advice
  • Tiredness: Get some rest
  • Immunosuppression: Regular blood tests
23
Q

EBRT late side effects and care management?

A
  • Decreases in sperm‐count (2‐3yrs only): Pre-cautionary sperm banking
  • Psychosocial issues for paediatrics
  • Dyspepsia, occasional peptic ulcer
  • Secondary cancers (~12% over 30y)

Pete 3 (11 decks)

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