Metastatic cancer

Question 1

IGCCCC based on

Answer 1

histology
location primary tumour
location mets
pre chemo markers

Question 2

IGCCCC Good prognosis

Answer 2

Seminoma 
Any primary
no non pul mets
normal AFP
any BHCG or LDH

NSGCT
primary testicle or RP
no non pul mets
S1

Question 3

IGCCCC Intermediate prognosis

Answer 3

Seminoma
any primary
any mets
Normal AFP
any HCG or LDH

NSGCT
testicular or RP primary
no non pul mets
S2

Question 4

IGCCCC Poor prognosis

Answer 4

No seminomas

NSGCT - non testical or RP primary i.e. mediastinal primary
non pulmonary mets
S3
LDH 10x
BCH >50,000
AFP >10,000

Question 5

IGCCCC Good prognosis survival

Answer 5

NSGCT 5 yr 92%

Seminoma 86%

Question 6

IGCCCC Int prognosis survival

Answer 6

NSGCT 5 yr 80%

Seminoma 72%

Question 7

POor prognosis survival

Answer 7

NSGCT 5 yr 48%

Question 8

stage IIa/B seminoma treatment

radiotherapy dose

Answer 8

3x BEP or x 4 EP if unable BEP
chemo and radiotheerapy equally effective

30 Gy - 36Gy

Question 9

stage II a /II b NSGCT

Answer 9

chemo to all NSGCT with raised tumour markers

if marker negative with IIa can repeat ct 6 weeks and reavaluate size
progression with RPLND or chemo

Question 10

stage 2c seminoma

Answer 10

3 cycles bep or 4 cylces ep good prognosis

itm prognosis 4 cycles BEP

Question 11

stage 2c NSGCT

Answer 11

3 cycles BEP good prognosis

itm prognsois 4 cycles BEP

Question 12

how much viable cancer following bep for nsgct

Answer 12

<10%
most necrotic tissue
if residual mass more than 1cm for RPLND

Question 13

consideration in poor prognosis disease

Answer 13

urgent chemotherapy
brain ct in chorio
High risk PEs > anti-coagulate when starting chemotherapy