GCT

Question 1

GCT tumor markers

Answer 1

bHCG: choriocarcinoma +- embryonal carcinoma

AFP: yolk sac
+- embryonal carcinoma
+- immature teratoma
also hepatoblastoma, HCC

Question 2

GCT predispositions

Answer 2

Klinefelter: mediastinal
Dysgerminoma: turner, Swyer, Frasier, Denys-Drash
T21

Hx cryptorchidism, hernia, hydrocele, TSPY positive gonadal dysgenesis

Question 3

GCT histology type 1 vs 2

Answer 3

Type 1: young; M test / F extragonadal; yolk sac +- teratoma

Type 2: AYA; gonadal; all histo

Question 4

GCT staging ix

Answer 4

CT/MR primary site
CT C/A/P
AFP, bHCG

seminoma/germinoma: PET
metastatic choriocarcinoma: brain MR
symptomatic: bone scan

Question 5

testicular GCT genetics

Answer 5

aneuploidy
+X, 7, 8, 12p, 21
-Y, 1p, 11, 13, 18

type II (AYA, gonadal): isochrome 12p

Question 6

GCT MAGIC risk stratification elements

Answer 6

site (extragonadal poorest < ovarian < testes)
stage
Age (11+yo worse)

Question 7

IGCCC risk stratification

Answer 7

see chart

site
mets
AFP/hCG
LDH

Nonseminoma
- Good Risk: test/retroperit and full resolution markers
- IR: test/retroperit and moderate reduction markers
- Poor Risk: mediastinal primary or nonpulm visceral mets; or post orchiectomy markers high

Seminoma
- Good Risk: no mets
- IR: nonpulm visceral mets

Question 8

GCT COG staging

Answer 8

I: CR, markers normalize
II: microscopic residual, persistent/rising markers, LN 1-2cm
III: gross residual, LN>2cm, + cytology, peritoneal implants
IV: distant mets

Question 9

GCT COG risk stratification / tx / px

Answer 9

LR: stage I; observe; >95%

SR1: Stage II-IV, <11yo
- PEb x4
- >85%

SR2: testic IGCCC good risk; extragonadal stage II; 11+yo
- BEP x3
- >85%

Poor risk: test IGCCC int/poor risk; extragonadal Stage III-IV; ovary stage IV
- BEPx4
- 50-75%

PEb = platinum, etop, bleo (1/cycle)
BEP = bleo, etop, platinum

Question 10

GCT RPLND indications

Answer 10

testicular non-LR
all adult testicular

10% risk of retrograde ejaculation

Question 11

AFP and bHCG half life

Answer 11

AFP: 5-7d
bHCG: 24-36h

Question 12

GCT chemo regimens

Answer 12

BEP (bleo etop pt)
- 4 cycles for poor risk
- 3 cycles for SR2

PEb (pt etop, bleo 1/cycle)
- 4 cycles for SR1

R/R: paclitaxel, ifos, cisplat

Question 13

GCT RT indications

Answer 13

emergency use for spinal cord compression
R/R

Question 14

choriocarcinoma syndrome

Answer 14

hemorrhage

single histology choriocarcinoma
typically type 2 (AYA)

Question 15

GCT histologies

Answer 15

Seminoma = Germinoma
- testes: seminoma
- ovary: dysgerminoma
- extragonadal: germinoma

Non-seminoma
- yolk sac
- embryonal carcinoma
- choriocarcinoma
- mixed

Question 16

GCT px

Answer 16

DFS >90%

except:
- ovarian II-III >11yo: 85%
- ovarian IV >11yo: 70%

• extragonadal IV >11yo 40%
• extragonadal III >11yo: 60%
• extragonadal IV <11yo: 80%
• test IV >11yo: 85%