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Testicular Cancer > CS 1 treatment > Flashcards

CS 1 treatment Flashcards

1
Q 
sperm banking
viral screen
how many samples
abstience
max storage
payment
max age storage
A 
fertility clinic
screen HIV, hep B and C
T, LH, FSH
3 samples with 2-3 days abstinence prior
sample forzen
maximum storage 10 years
up to 55 years old
1st year NHS pays then £200 per year
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2
Q

% azoospermic before orchidectomy

% abnormal sperm counts

A

10-24% azoospermic

50% abnormal sperm counts

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3
Q

when does sperms return after chemo

A

after 4 years post chemo

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4
Q

complications prosthesis

A

almost all discomfort swelling bruising
1/2 to 1/10 higher different size, feel stitch
1/6 dissastifaction result
up to 1/250 bleeding, infection, pain, chronic, leakage, unknown long term risk silicone

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5
Q

risk of tumour in CL biopsy
risk of GCNIS
general GCNIS risk pop

A

GCNIS 9%
risk tumour 2.5%
background GCNIS
general risk 0.8%

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6
Q

progression GCNIS to cancer

A

50% five years 70% 7 years

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7
Q

risk GCNIS with Harland criteria

A

under 30 and 12mls or less 18-34% incidence

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8
Q

type of CL biopsy

A

2 site biopsy recommended Dieckmann Eur Urol 2007

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9
Q

radiotherapy for GCNIS

A

20Gy in 2Gy fractions

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10
Q

risk relapse seminoma with rete testis and 4cm

A

32% vs 6% relapse

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11
Q

chemo for seminoma

A

carboplatin x 1 or DXT for higher risk relapse

4cm rete testis

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12
Q

Stage 2 or 3 seminoma

A

3 x BEP

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13
Q

Residual mass after seminoma treatment

A

> 3cm FDG PET at least 2 months after chemo

<3cm follow up imaging serum markers

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14
Q

NSGCT stage 1

A

with LVI BEP x 1 (RPLND)

no LVI surveillance

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15
Q

NSGCT pure teratoma

A

RPLND

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16
Q

NSGCT stage 2 A/B marker negative and positive

A

BEP x 3

M-ve RPLND - if positive BEP x 2

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17
Q

NSGCT porpotion with subclinical mets

A

50% subclinical mets

92% present first 2 years

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18
Q

Stage 2C NSGCT good and poor prognosis

A

good prognosis BEP x 3

intermediate or poor prognosis BEP x 4

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19
Q

residual mass NSGCT after chemo

necrosis vs viable tumour

A

if >1cm RPLND
10% viable tumour, 50% teratoma. 40% necrosis

if <1cm uncertain follow up with imaging and tumour markers

20
Q

action of cisplatin

side effects

A

inhibits DNA synthesis
neuro
oto
nephro

21
Q

bleomycin mode action

A

anti tumour antibiotics
cases DNA stand break
pulmonary fibrosis

22
Q

etoposide action

side effect

A

topoisomerase 2 inhibitor
induces cell arrest
causes myelosuppression and hair loss

23
Q

RPLND template

A

RIGHT
right renal vein to lateral border aorta
right ureter
right bifurcation common iliac

LEFT
left renal vein
left ureter
medial border aorta
left common iliac bifurcation
24
Q

side effects RPLND
morbidity
mortality

A

morbidity 10%
mortality 0.5-1%

1/2 to 1/10
weak absent ejcaultion
lymphocele
infection incision site bulging, pain
ileus

1 in 10
need removal of organ

1 in 10 to 1 in 50
bleeding
further treatment
injury other structures
entry to lung cavity drain
25
Q 
Primary RPLND
who for , who many be suitable
how many will cure
how many operated unessecarily
how many develop mets need salvage chemo
A

for stage 1 NSGCT, those unwilling to do surveillance or primary chemo
cure 90% of CS 1 without need chemo
and provides accurate staging
70% operated unescearily as only 30% will relapse
and in 10% after RPLND will still develop systemic mets requiring salvage chemo

26
Q

who can have TSS

rate associated GCNIS

A

tumour less than 30% of volume of testicle
synchronous bilateral
metachronous bilateral
solitary testis with normal preop T levels
rate of associated GNCIS 82%

27
Q

radical orchidectomy consent

A

almost all
swelling bruising scrotum

10-50%
high position
feel stitch

20%
not happy look prosthesis

2-10%
not cancer
not cured
need c/l biopsy
need remove implant
fertility
cosmetic result

<1%
bleeding infection pain

<0.04%
leakage implant
anesthetic risk

28
Q

complications prosthesis

A

extrusion 5%
migration 5%
chronic pain 1%

29
Q

paper testicular prosthesis

A

Ramani
904 men
rate infection same

30
Q

indications organ sparing 4

A

solitary testicle with normal testosterone levels with tumour
contra lateral TC
tumour <30% of testicle volume
strong suspcicion benign tumour

31
Q

maximun storage sperm

A

10 years or age 55 in NHS

32
Q

cost sperm banking after 1st year

A

£200

covered in 1st year

33
Q

azoospermic if banking not done before orchidectomy

A

4-10% will be azoospermic if sperm banking not done before orchidectomy

34
Q

surveillance protocol stage 1 seminoma

A

year 1-3
6 monthly ct and 6 monthly clinnic assessment
no cxr
then once in year 4-5 then tailored

35
Q

surveillance protocol stage 1 NSGCt

A

3 montly doctor visit year 1-2, then 6 montly year 3

6 monthly ct and cxr

36
Q

how many later relapses of seminoa after 4 years

A

20%

37
Q

how many NSGCT have sub clinic mets

A

30% so will relapse on surveillance

38
Q

what are adverse features of NSGCT

A

embryonal compinent

lack yolk sac component

39
Q

salvage chemo in NSGCT response rate

A

very good >99% so surveillance is option

40
Q

what proportion relapse year 1 NSGCT

A

80%

of which 1/3 will have normal tumour markers

41
Q

how is BEP given

A

3 weeks

2 weeks of chemo with 1 week rest

42
Q

RPLND role in NSGCT

what happens if LN on RPLND

A

if unwilling chemo or surveillance
if LN then have 2 cycles BEP if stage II NSGCT
Some patients may wish to consider primary RPLND although they need to be aware of the potential additional requirement of adjuvant chemotherapy if nodes contain active disease, as well as the 10% risk of systemic relapse requiring subsequent chemotherapy treatment (BEP X 3).

43
Q

RPLND role in NSGCT

what happens if LN on RPLND

A

if unwilling chemo or surveillance
if LN then have 2 cycles BEP if stage II NSGCT
Some patients may wish to consider primary RPLND although they need to be aware of the potential additional requirement of adjuvant chemotherapy if nodes contain active disease, as well as the 10% risk of systemic relapse requiring subsequent chemotherapy treatment (BEP X 3).

44
Q

relapse rate after ajuvant bep in stage 1 nsgct

A

less than 3%

Adjuvant chemotherapy with BEP is superior to adjuvant RPLND in terms of the risk of relapse

45
Q

sperm quality papers

A

Rives 2012
semen quality

Peterson JCO 1999

50% drop in semen parameters post orchidectomy
10% will become azoospermic post orchidectomy
10% will be azoospermic before orchidectomy

46
Q

risk relapse after chemo for stage I seminoma

A

In non-randomised prospective series five-year relapse rates with adjuvant carboplatin are 2% in patients without risk factors and 9% in patients with one or two risk factors

single cycle carboplatin (MRC trial showed lowest toxicity and equal low relapse of2% comparing carbo vs RT 30Gy vs RT 20Gy

47
Q

pros and cons adjuvant radio vs chemo in stage 1

A

Adjuvant chemotherapy with one course carboplatin AUC 7 is not inferior to adjuvant radiotherapy when pathological risk-factors are taken into account.

Relapse rates with both adjuvant treatments are
around 5%.

Adjuvant radiotherapy is associated with an increased risk of developing secondary non-germ cell malignancies

Testicular Cancer (9 decks)

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