Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline (2019) Flashcards
what are risk factors for developing testis cancer?
GCNIS, white race, history of UDT, family history of testicular Ca, personal history of testicular Ca
what gene has been associated with testis cancer?
polymorphisms of gene encoding c-KIT ligand, maybe CHEK2 as well
what are the different kinds of NSGCT?
embryonal, choriocarcinoma, yolk sac tumor, teratoma, pure or mixed together
What do you call a tumor on path if it is 99% seminoma and 1 NSGCT
NSGCT
what NSGCT subtype is most undifferentiated?
Embryonal (it can become other types at primary and metastatic site)
what somatic malignancy is teratoma gonna convert to
sarcoma, adenocarcinoma
which testis tumors produce AFP? what is the half-life of AFP?
yok sac and EC, 5-7 days,
if seminoma has elevated AFP it is considered NSGCT
which testis tumors produce b-hcg? half-life?
10-15% of seminoma (syncthitrophoblast cells)
choriocarcinomas, EC,
24-36 hours
what can cause a false positive elevation of beta hcg?
hypogonadism, some medications, liver, kidney, biliary cancers, stomach lung breast cancer
which isoenzyme of LDH is elevated in GCT?
LDH-1
what are treatment and initial management decision post orchiectomy are dictated by?
Pathological stage of the tumor, post-orchiectomy tumor markers, staging as determined by exam and imaging
what is the most common solid malignancy among men 20-40 years old?
testicular cancer
should tumor markers be drawn and measured prior to treatment for testis cancer( Orch)?
yes. help you know sem vs non sem
Sem on path with high AFP should be treated as non sem
what percentage of men with GCT are azoospermic at diangosis or have impaired semen parameters?
10%
50%
how long does it take after cisplatin based chemo for spermatogenic function to recover
2-5 years
what dose of radiation can cause azoospermia?
6Gy or more
bellow that the more you give the longer the spermatogenesis recovery will take
What for of local imaging should you order for patients with unilateral or bilateral suspicious scrotal mass?
Scrotal US
what do seminomas look like on US? what about Non seminomas?
seminoma hypoechoic, homogeneous
NSGCT: heterogenous with irregular margins, irregular margins, cystic areas, echogenic foci, calcification, hemorrhage and fibrosis
what would a burned out tumor on US look like?
a nonpalpable scar or calcification
what is the significance of testicular microlithiasis?
men with GCT risk factors( UDT, family history, personal history) should be counselled about self exam and increased risk of GCT and be followed by a medical professional. otherwise not necessary
what is he management of a man with tumor<10mm on US, normal serum markers and negative metastatic work up?
diagnostic dilemma, repeat US in 4 to 8 weeks
tx options: orch, observation, partial orch with intra op frozen section. do shared decision making.
is there a role for MRI in work up of testicular lesions?
not really, don’t delay orch
where should do spermatic cord be taken?
internal inguinal ring
should testicualr prosthesis be offered prior to orch?
it should be discussed, most patients are satisfied after
what are issues with scrotal orch? how can this be mitigated if you accidentally do one on cancer?
higher local recurrence rates,
can offer resection of surgical scar,
