CS 1 treatment

Question 1

sperm banking
viral screen
how many samples
abstience
max storage
payment
max age storage

Answer 1

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

Question 2

% azoospermic before orchidectomy

% abnormal sperm counts

Answer 2

10-24% azoospermic

50% abnormal sperm counts

Question 3

when does sperms return after chemo

Answer 3

after 4 years post chemo

Question 4

complications prosthesis

Answer 4

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

Question 5

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

Answer 5

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

Question 6

progression GCNIS to cancer

Answer 6

50% five years 70% 7 years

Question 7

risk GCNIS with Harland criteria

Answer 7

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

Question 8

type of CL biopsy

Answer 8

2 site biopsy recommended Dieckmann Eur Urol 2007

Question 9

radiotherapy for GCNIS

Answer 9

20Gy in 2Gy fractions

Question 10

risk relapse seminoma with rete testis and 4cm

Answer 10

32% vs 6% relapse

Question 11

chemo for seminoma

Answer 11

carboplatin x 1 or DXT for higher risk relapse

4cm rete testis

Question 12

Stage 2 or 3 seminoma

Answer 12

3 x BEP

Question 13

Residual mass after seminoma treatment

Answer 13

> 3cm FDG PET at least 2 months after chemo

<3cm follow up imaging serum markers

Question 14

NSGCT stage 1

Answer 14

with LVI BEP x 1 (RPLND)

no LVI surveillance

Question 15

NSGCT pure teratoma

Answer 15

RPLND

Question 16

NSGCT stage 2 A/B marker negative and positive

Answer 16

BEP x 3

M-ve RPLND - if positive BEP x 2

Question 17

NSGCT porpotion with subclinical mets

Answer 17

50% subclinical mets

92% present first 2 years

Question 18

Stage 2C NSGCT good and poor prognosis

Answer 18

good prognosis BEP x 3

intermediate or poor prognosis BEP x 4

Question 19

residual mass NSGCT after chemo

necrosis vs viable tumour

Answer 19

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

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

Question 20

action of cisplatin

side effects

Answer 20

inhibits DNA synthesis
neuro
oto
nephro

Question 21

bleomycin mode action

Answer 21

anti tumour antibiotics
cases DNA stand break
pulmonary fibrosis

Question 22

etoposide action

side effect

Answer 22

topoisomerase 2 inhibitor
induces cell arrest
causes myelosuppression and hair loss

Question 23

RPLND template

Answer 23

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

Question 24

side effects RPLND
morbidity
mortality

Answer 24

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

Question 25

``` Primary RPLND who for , who many be suitable how many will cure how many operated unessecarily how many develop mets need salvage chemo ```

Answer 25

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

Question 26

who can have TSS | rate associated GCNIS

Answer 26

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

Question 27

radical orchidectomy consent

Answer 27

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

Question 28

complications prosthesis

Answer 28

extrusion 5% migration 5% chronic pain 1%

Question 29

paper testicular prosthesis

Answer 29

Ramani 904 men rate infection same

Question 30

indications organ sparing 4

Answer 30

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

Question 31

maximun storage sperm

Answer 31

10 years or age 55 in NHS

Question 32

cost sperm banking after 1st year

Answer 32

£200 | covered in 1st year

Question 33

azoospermic if banking not done before orchidectomy

Answer 33

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

Question 34

surveillance protocol stage 1 seminoma

Answer 34

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

Question 35

surveillance protocol stage 1 NSGCt

Answer 35

3 montly doctor visit year 1-2, then 6 montly year 3 | 6 monthly ct and cxr

Question 36

how many later relapses of seminoa after 4 years

Answer 36

20%

Question 37

how many NSGCT have sub clinic mets

Answer 37

30% so will relapse on surveillance

Question 38

what are adverse features of NSGCT

Answer 38

embryonal compinent | lack yolk sac component

Question 39

salvage chemo in NSGCT response rate

Answer 39

very good >99% so surveillance is option

Question 40

what proportion relapse year 1 NSGCT

Answer 40

80% | of which 1/3 will have normal tumour markers

Question 41

how is BEP given

Answer 41

3 weeks | 2 weeks of chemo with 1 week rest

Question 42

RPLND role in NSGCT | what happens if LN on RPLND

Answer 42

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).

Question 43

RPLND role in NSGCT | what happens if LN on RPLND

Answer 43

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).

Question 44

relapse rate after ajuvant bep in stage 1 nsgct

Answer 44

less than 3% | Adjuvant chemotherapy with BEP is superior to adjuvant RPLND in terms of the risk of relapse

Question 45

sperm quality papers

Answer 45

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

Question 46

risk relapse after chemo for stage I seminoma

Answer 46

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

Question 47

pros and cons adjuvant radio vs chemo in stage 1

Answer 47

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