Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline (2019)

Question 1

what are risk factors for developing testis cancer?

Answer 1

GCNIS, white race, history of UDT, family history of testicular Ca, personal history of testicular Ca

Question 2

what gene has been associated with testis cancer?

Answer 2

polymorphisms of gene encoding c-KIT ligand, maybe CHEK2 as well

Question 3

what are the different kinds of NSGCT?

Answer 3

embryonal, choriocarcinoma, yolk sac tumor, teratoma, pure or mixed together

Question 4

What do you call a tumor on path if it is 99% seminoma and 1 NSGCT

Answer 4

NSGCT

Question 5

what NSGCT subtype is most undifferentiated?

Answer 5

Embryonal (it can become other types at primary and metastatic site)

Question 6

what somatic malignancy is teratoma gonna convert to

Answer 6

sarcoma, adenocarcinoma

Question 7

which testis tumors produce AFP? what is the half-life of AFP?

Answer 7

yok sac and EC, 5-7 days,

if seminoma has elevated AFP it is considered NSGCT

Question 8

which testis tumors produce b-hcg? half-life?

Answer 8

10-15% of seminoma (syncthitrophoblast cells)
choriocarcinomas, EC,
24-36 hours

Question 9

what can cause a false positive elevation of beta hcg?

Answer 9

hypogonadism, some medications, liver, kidney, biliary cancers, stomach lung breast cancer

Question 10

which isoenzyme of LDH is elevated in GCT?

Answer 10

LDH-1

Question 11

what are treatment and initial management decision post orchiectomy are dictated by?

Answer 11

Pathological stage of the tumor, post-orchiectomy tumor markers, staging as determined by exam and imaging

Question 12

what is the most common solid malignancy among men 20-40 years old?

Answer 12

testicular cancer

Question 13

should tumor markers be drawn and measured prior to treatment for testis cancer( Orch)?

Answer 13

yes. help you know sem vs non sem

Sem on path with high AFP should be treated as non sem

Question 14

what percentage of men with GCT are azoospermic at diangosis or have impaired semen parameters?

Answer 14

10%

50%

Question 15

how long does it take after cisplatin based chemo for spermatogenic function to recover

Answer 15

2-5 years

Question 16

what dose of radiation can cause azoospermia?

Answer 16

6Gy or more

bellow that the more you give the longer the spermatogenesis recovery will take

Question 17

What for of local imaging should you order for patients with unilateral or bilateral suspicious scrotal mass?

Answer 17

Scrotal US

Question 18

what do seminomas look like on US? what about Non seminomas?

Answer 18

seminoma hypoechoic, homogeneous
NSGCT: heterogenous with irregular margins, irregular margins, cystic areas, echogenic foci, calcification, hemorrhage and fibrosis

Question 19

what would a burned out tumor on US look like?

Answer 19

a nonpalpable scar or calcification

Question 20

what is the significance of testicular microlithiasis?

Answer 20

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

Question 21

what is he management of a man with tumor<10mm on US, normal serum markers and negative metastatic work up?

Answer 21

diagnostic dilemma, repeat US in 4 to 8 weeks

tx options: orch, observation, partial orch with intra op frozen section. do shared decision making.

Question 22

is there a role for MRI in work up of testicular lesions?

Answer 22

not really, don’t delay orch

Question 23

where should do spermatic cord be taken?

Answer 23

internal inguinal ring

Question 24

should testicualr prosthesis be offered prior to orch?

Answer 24

it should be discussed, most patients are satisfied after

Question 25

what are issues with scrotal orch? how can this be mitigated if you accidentally do one on cancer?

Answer 25

higher local recurrence rates,

can offer resection of surgical scar,