Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EAMC Urology > NCCN Testicular 3.2020 > Flashcards

NCCN Testicular 3.2020 Flashcards

1
Q

Initial workup

Suspicious testicular mass

A

H and PE
AFP, beta-HCG, LDH
Chemistry profile (baseline gonadal function)
Testicular ultrasound

TEST-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary treatment

Suspicious testicular mass

A

Radical inguinal orchiectomy
Sperm banking
Consider INGUINAL biopsy
Consider testicular prosthesis

TEST-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications for inguinal biopsy of contralateral testis

A

Ultrasound: intratesticular mass concerning for testicular CA
Cryptorchid testis
Marked atrophy
Suspicious mass

TEST-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Postdiagnostic workup
Pure seminoma (pure seminoma histology + AFP normal, -/+ elevated beta-HCG
A 
Abdominal pelvic CT
CXR --> Chest CT if (+) abd. CT or CXR
Post-orchiectomy beta-HCG, LDH, and AFP
Brain MRI, if indicated
Sperm banking

TEST-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is TNM staging based on post or pre orchiectomy values of tumor markers?

A

TNM staging is based on POST-ORCHIECTOMY values of tumor markers.

TEST-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Primary treatment: Pure seminoma

IA, IB

A 
Surveillance for pT1-pT3 tumors (strongly preferred)
OR
Single-agent carboplatinp,q
(AUC=7 x 1 cycle or AUC=7 x 2 cycles)
OR
RT (20 Gy or 25.5 Gy)

TEST-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Primary treatment: Pure seminoma

IS

A

Repeat elevated serum tumor marker measurement and asses with chest/abdominal/pelvic CT (with contrast) to scan for evaluable disease

TEST-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary treatment: Pure seminoma

IIA

A

RT to include para-aortic and ipsilateral iliac lymph nodes to a dose of 30 Gy
OR
Primary chemotherapy
BEP for 3 cycles or EP for 4 cycles

TEST-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Primary treatment: Pure seminoma

IIB

A

Primary chemotherapy
BEP for 3 cycles or EP for 4 cycles
OR
RT in select non-bulky (≤3 cm) cases to include para-aortic and ipsilateral iliac lymph nodes to a dose of 36 Gy

TEST-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Primary treatment: Pure seminoma
IIC, III
Good risk

A

Primary chemotherapy
BEP for 3 cycles (cat 1)
OR
EP for 4 cycles (cat 1)

TEST-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primary treatment: Pure seminoma
IIC, III
Intermediate risk

A

Primary chemotherapy
BEP for 4 cycles (cat 1)
OR
VIP for 4 cycles (cat 1)

TEST-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Imaging: no residual mass, or =< 3 cm 
Markers: normal AFP, beta-HCG
A

Surveillance

TEST-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Imaging: Residual mass, > 3 cm 
Markers: normal AFP, beta-HCG
A

Surveillance
OR
Consider PET/CT scan from skull base to mid- thigh (6 wks
or more post- chemotherapy)
- If (+), resect residual mass or biopsy, then if (+) viable seminoma with complete resection –> 2 cycles of adjuvant chemo
- If incomplete resection: second line chemo

TEST-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Progressive disease: rising tumor markers, growing mass

A

Second-line therapy:

Clinical trial (preferred)
Chemotherapy
- Conventional-dose therapy (VeIP or TIP)
- High-dose chemotherapy
Consider surgical salvage if solitary site (for early relapse)
Recommend sperm banking if clinically indicated

TEST-5, TEST-13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Primary treatment: NSGCT

Post-diagnostic workup

A

Chest/abdominal/pelvic CT
Repeat beta-HCG, LDH, AFP
Brain MRI if indicated
Sperm banking

TEST-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary treatment: NSGCT

Stage I WITHOUT risk factors

A 
Surveillance (preferred)
OR
Nerve-sparing RPLND
OR
Primary chemotherapy: BEP x 1 cycle

TEST-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Primary treatment: NSGCT

Stage I WITH risk factors

A 
Surveillance
OR
Primary chemotherapy: BEP x 1 cycle
OR
Nerve-sparing RPLND

TEST-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Primary treatment: NSGCT

Stage IS

A 
Check for persistent marker elevation
---
Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)

TEST-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Primary treatment: NSGCT

Stage IIA, markers negative

A

Nerve-sparing RPLND
OR
Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles

TEST-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Primary treatment: NSGCT

Stage IIA, persistent marker elevation

A

Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)

TEST-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Primary treatment: NSGCT

Stage IIB, markers negative , LN mets within lymphatic drainage sites

A

Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles
or
Nerve-sparing RPLND in highly selected cases

TEST-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Primary treatment: NSGCT

Stage IIB, markers negative , multifocal symptomatic or LN mets with aberrant lymphatic drainage

A

Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles

TEST-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Primary treatment: NSGCT

Stage IIB, persistent marker elevation

A

Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)

TEST-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Postchemotherapy management: NSGCT
Stage IIA, IIB
Negative markers, residual mass (≥1 cm) on CT scan

A

Nerve-sparing bilateral RPLND

TEST-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Postchemotherapy management: NSGCT Stage IIA, IIB Negative markers, no mass, or residual mass <1 cm on CT scan
Surveillance OR Nerve-sparing bilateral RPLND in selected cases (category 2B) TEST-9
26
Postsurgical management: NSGCT Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND pN0
Surveillance TEST-10
27
Postsurgical management: NSGCT Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND pN1
``` Surveillance (preferred) or Chemotherapy: BEP for 2 cycles or EP for 2 cycles ``` TEST-10
28
Postsurgical management: NSGCT Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND pN2
``` Chemotherapy (preferred): BEP for 2 cycles or EP for 2 cycles or Surveillance ``` TEST-10
29
Postsurgical management: NSGCT Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND pN3
Chemotherapy: BEP for 3 cycles or EP for 4 cycles TEST-10
30
Primary treatment: NSGCT Intermediate risk Stage IIIB
``` Primary chemotherapy: BEP for 4 cycles (category 1) or VIP for 4 cycles (category 1) ``` TEST-11
31
Primary treatment: NSGCT Poor risk Stage IIIC
Primary chemotherapy: BEP for 4 cycles (category 1) or VIP for 4 cycles in selected patients (category 1) TEST-11
32
Primary treatment: NSGCT | Brain metastases
Primary chemotherapy ± RT ± surgery, if clinically indicated TEST-11
33
Post-chemotherapy management: NSGCT Partial response, residual masses with normal AFP and beta-hCG levels Surgical resection of all residual masses: Teratoma or necrosis
Surveillance TEST-12
34
Post-chemotherapy management: NSGCT Partial response, residual masses with normal AFP and beta-hCG levels Surgical resection of all residual masses: Residual embryonal, yolk sac, choriocarcinoma, or seminoma element
Chemotherapy for 2 cycles (EP or TIP or VIP or VeIP) TEST-12
35
Post-chemotherapy management: NSGCT Partial response, residual masses with abnormal AFP and/or beta-hCG levels Elevated and rising AFP and/ or beta-hCG levels
Second-line therapy Preferred Regimens • TIP1 Paclitaxel 250 mg/m2 IV on Day 1 Ifosfamide 1500 mg/m2 IV on Days Cisplatin 25 mg/m2 IV on Days 2–5 Repeat every 21 days • VeIP1 Vinblastine 0.11 mg/kg IV Push on Ifosfamide 1200 mg/m2 IV on Days Cisplatin 20 mg/m2 IV on Days 1–5 Repeat every 21 days TEST-12, TEST-F
36
Post-chemotherapy management: NSGCT Partial response, residual masses with abnormal AFP and/or beta-hCG levels Elevated but stable AFP and/or beta- hCG levels
Close surveillance TEST-12
37
Post-chemotherapy management: NSGCT Partial response, residual masses with abnormal AFP and/or beta-hCG levels Mildly elevated and normalizing AFP and/ or beta-hCG levels
Resection of all residual masses: - Teratoma or necrosis: surveillance - Residual embryonal, yolk sac, chorio- carcinoma, or seminoma element: Chemotherapy for 2 cycles (EP or TIP or VIP or VeIP) TEST-12
38
Recurrence: NSGCT (second-line) Prior chemotherapy: early relapse (recurrence =< 2 years after completion of primary treatment)
Second-line therapy: Clinical trial (preferred) Chemotherapy - Conventional-dose therapy (VeIP or TIP) - High-dose chemotherapy Consider surgical salvage if solitary site (for early relapse) Recommend sperm banking if clinically indicated TEST-13
39
Recurrence: NSGCT (second-line) Prior chemotherapy: laterelapse (recurrence > years after completion of primary treatment)
Surgical salvage, if resectable (preferred) Clinical trial, if unresectable Chemotherapy - Conventional-dose therapy (VeIP or TIP) - High-dose chemotherapy Recommend sperm banking if clinically indicated TEST-13
40
Recurrence: NSGCT (second-line) No prior chemotherapy
Treat per risk status and recommend sperm banking TEST-13
41
Post second-line therapy: NSGCT Complete response, negative markers
Surveillance or Nerve-sparing bilateral RPLND in selected cases (cat 2B) TEST-14
42
Post second-line therapy: NSGCT Partial response, residual masses with normal AFP and beta-HCG levels
Surgical resection of all residual masses, then: any histology Surveillance TEST-14
43
Post second-line therapy: NSGCT Partial response residual masses with abnormal AFP and/or beta-hCG levels Elevated and rising AFP and/or beta-hCG levels
Third-line therapy: Preferred Regimens (High-Dose Chemotherapy) • Carboplatin/etoposide Carboplatin 700 mg/m2 (body surface area) IV Etoposide 750 mg/m2 IV 1 Administered 5, 4, and 3 days before peripheral blood stem cell infusion for 2 cycles • Paclitaxel/ifosfamide/carboplatin/etoposide Paclitaxel 200 mg/m2 IV over 24 hours on Day 1 Ifosfamide 2000 mg/m2 over 4 hours with mesna protection on Days 2–4 Repeat every 14 days for 2 cycles followed by Carboplatin AUC 7–8 IV over 60 minutes on Days 1–3 Etoposide 400 mg/m2 IV on Days 1–3 2 Administered with peripheral blood stem cell support at 14- to 21-day intervals for 3 cycles TEST-G
44
Recurrence after second-line: NSGCT | Prior first- and second-line conventional dose chemotherapy
``` Clinical trial (preferred) or High-dose chemotherapy or Consider surgical salvage if solitary site ``` TEST-15
45
Recurrence after second-line: NSGCT | Prior high-dose chemotherapy
Clinical trial (preferred) or Conventional dose salvage chemotherapy or Consider surgical salvage if solitary site or MSI/MMR testing if progression after high-dose chemotherapy or third-line therapy TEST-15
46
Late relapse | recurrence >2 years after completion of second- line chemotherapy
Surgical salvage, if resectable (preferred) or Chemotherapy • Conventional-dose therapy • High-dose chemotherapy (if not previously received) TEST-15
47
RT for pure seminoma: RT should start ________. Patients should be treated _______ (frequency)
Once the orchiectomy wound has fully healed. 5 days per week.
48
Risk Classification for Advanced Disease (post-orchiectomy: GOOD RISK, NSGCT
Testicular or retroperitoneal primary tumor and No nonpulmonary visceral metastases and Post-orchiectomy markers- all of: AFP < 1,000 ng/mL hCG < 5,000 iu/L LDH < 1.5 x upper limit of normal TEST-D
49
Risk Classification for Advanced Disease (post-orchiectomy: GOOD RISK, Seminoma
``` Any primary site and No nonpulmonary visceral metastases and Normal AFP Any hCG Any LDH ``` TEST-D
50
Risk Classification for Advanced Disease (post-orchiectomy: INTERMEDIATE RISK, NSGCT
Testicular or retroperitoneal primary tumor and No nonpulmonary visceral metastases and Post-orchiectomy markers- any of: AFP 1,000–10,000 ng/mL hCG 5,000–50,000 iu/L LDH 1.5–10 x upper limit of normal TEST-D
51
Risk Classification for Advanced Disease (post-orchiectomy: INTERMEDIATE RISK, Seminoma
``` Any primary site and Nonpulmonary visceral metastases and Normal AFP Any hCG Any LDH ``` TEST-D
52
Risk Classification for Advanced Disease (post-orchiectomy: POOR RISK, NSGCT
``` Mediastinal primary tumorb or Nonpulmonary visceral metastases or Post-orchiectomy markers- any of: AFP > 10,000 ng/mL hCG > 50,000 iu/L LDH > 10 x upper limit of normal ``` TEST-D
53
Risk Classification for Advanced Disease (post-orchiectomy: POOR RISK, Seminoma
No patients classified as poor prognosis
54
Staging | pTis
Germ cell neoplasia in situ
55
Staging pT1 pT1a pT1b
Tumor limited to testis (including rete testis invasion) without lymphovascular invasion T1a Tumor smaller than 3 cm in size T1b Tumor 3 cm or larger in size ST-1
56
Staging | pT2
Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR Tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion ST-1
57
Staging | pT3
Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion ST-1
58
Staging | pT4
Tumor invades scrotum with or without lymphovascular invasion ST-1
59
Staging | cN1
Metastasis with a lymph node mass 2 cm or smaller in greatest dimension OR Multiple lymph nodes, none larger than 2 cm in greatest dimension ST-2
60
Staging | cN2
Metastasis with a lymph node mass larger than 2 cm but not larger than 5 cm in greatest dimension OR Multiple lymph nodes, any one mass larger than 2 cm but not larger than 5 cm in greatest dimension ST-2
61
Staging | cN3
Metastasis with a lymph node mass larger than 5 cm in greatest dimension ST-2
62
Staging | pN1
Metastasis with a lymph node mass 2 cm or smaller in greatest dimension and less than or equal to five nodes positive, none larger than 2 cm in greatest dimension ST-2
63
Staging | pN2
Metastasis with a lymph node mass larger than 2 cm but not larger than 5 cm in greatest dimension; or more than five nodes positive, none larger than 5 cm; or evidence of extranodal extension of tumor ST-2
64
Staging | pN3
Metastasis with a lymph node mass larger than 5 cm in greatest dimension ST-2
65
Staging M1a M1b
M1a: Non-retroperitoneal nodal or pulmonary metastases M1b: Non-pulmonary visceral metastases
66
Staging | S1
LDH <1.5 x N* and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000
67
Staging | S2
LDH 1.5–10 x N* or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000
68
Staging | S3
LDH >10 x N* or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000

EAMC Urology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions