Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro / GU > SM_228b: Testis Cancer > Flashcards

SM_228b: Testis Cancer Flashcards

1
Q

Describe the anatomy of the testis

A

Testis anatomy

  • Covered by tunica albuginea
  • Arterial supply: testicular artery (from aorta), vasal artery (from superior vesical arrery)
  • Venous return: pampiniform plexus -> gonadal vein, right -> IVC, left -> renal vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

This is testis undergoing ____

A

This is testis undergoing spermatogenesis

  • Spermatogonia -> spermatocytes -> spermatids -> spermatozoa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This is a ___ found in ___ that is responsible for ___

A

This is a Crystal of Reinke found in Leydig cells that is responsible for hormone production

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

Describe the epidemiology of testicular cancer

A

Epidemiology of testicular cancer

  • Most common between age 15-35
  • 95% of germ cell origin while 5% are Leydig, Sertoli cell, and other variants
  • 2-3% incidence of bilateral tumors
  • Incidence has increased 50% over the last 20-30 years in Caucasian and Hispanics
  • Relatively uncommon in Asians and very rare in African Americans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe epidemiology of bilateral testis tumors

A

Bilateral testis tumors

  • 1-4% incidence
  • 20-30% are synchronous
  • 70-80% are metachronous
  • Median time between tumors of 5 years
  • Long term survival approaches 90%
  • Seminoma is the most common histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Testicular cancer originates from ____, 90% arise ____, and the precursor lesion is ____

A

Testicular cancer originates from pluripotent germ cell, 90% arise within the testes, and the precursor lesion is intratubular germ cell neoplasia

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

____ which causes ____ is shown in most testicular GCTs

A

l(12p) which causes duplication of the short arm of chromosome 12 is shown in most testicular GCTs

  • No corewlation with prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe signs and symptoms of testicular cancer

A

Signs and symptoms of testicular cancer

  • Mass or swelling
  • Pain (usually mild, NSGCT > seminoma)
  • Hydrocele / hematocele
  • Gynecomastia ± mastodynia
  • Chest pain, dyspnea, cough
  • Abdominal / back pain
  • CNS symptoms
  • Lower extremity swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

____ is often misdiagnosed as orchitis and/or epididymitis

A

Testicular cancer is often misdiagnosed as orchitis and/or epididymitis

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

Describe diagnosis of testicular cancer

A

Diagnosis of testicular cancer

  • Self-examination
  • Mass with induration ± pain
  • (-) transillumination
  • Scrotal ultrasound
  • B-hCG
  • AFP
  • LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hCG is a product of ____ and elevated in 40-60% of patients with ____ and 15% of patients with ____

A

hCG is a product of syncytiotrophoblasts and elevated in 40-60% of patients with testis cancer and 15% of patients with pure seminoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

___ is NEVER seen in pure seminoma or pure choriocarcinoma

A

AFP is NEVER seen in pure seminoma or pure choriocarcinoma

  • Product of yolk sac elements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

___ > 200 U/dl is usually a reliable marker of GCTs and is a particularly useful tumor marker for advanced seminomas

A

LDH > 200 U/dl is usually a reliable marker of GCTs and is a particularly useful tumor marker for advanced seminomas

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

Describe initial management of a testicular tumor

A

Initial management of a testicular tumor

  • Sperm bank
  • 20-60% of GCT patients have abnormal preop semen analysis
  • Help patients make an informed decision about the pros / cons of inserting a testicular prosthesis
  • Perform a radical (inguinal) orchiectomy: decreases chance of cutting into the tumor and subsequent contamination of scrotal lymphatics, removes in transit disease located within lymphatics of the spermatic cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Partial orchiectomy is ____

A

Partial orchiectomy is never a good idea

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

Describe pathology of testicular neoplasms

A

Pathology of testicular neoplasms

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

This is a ___

A

This is a seminoma

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

This is a ___

A

This is an embryonal carcinoma

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

This is a ____

A

This is a yolk sac tumor

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

Choriocarcinoma is composed of two types of tumor cells: ____ and ____

A

Choriocarcinoma is composed of two types of tumor cells: syncytiotrophoblasts (b-hCG) and cytotrophoblasts

21
Q

Describe staging testis cancer

A

Staging testis cancer

  • CXR (clinical stage 1) or seminoma
  • CAT scan of chest (clinical stage 2, 3)
  • CAT scans of abdomen and pelvis
  • Post-orchiectomy tumor markers
  • MRI (great vessels, liver)
  • PET scan (post-chemotherapy seminoma)
22
Q

Testis cancer advanced stage disease may involve ____ or ____

A

Testis cancer advanced stage disease may involve supraclavicular lymph node metastases or massive retroperitoneal lymph nodes

23
Q

Describe lymphatic drainage of testis

A

Lymphatic drainage of testis

  • R testis: interaortocaval, pre-caval, pre-aortic
  • L testis: para-aortic, pre-aortic, interaortocaval
  • Inguinal lymph nodes: not commonly involved in absence of tunica / scrotal wall invasion or disruption in normal lymphatic flow
  • Iliac lymph nodes: potentially involved with epididymal / cord invasion, cryptorchidism, previous inguinal injury
24
Q

Describe the AJCC staging system for testicular cancer

A

AJCC staging system for testicular cancer

  • I: confined to testis
  • IS: confined to testis with post-orchiectomy elevation of serum tumor markers
  • II: retroperitoneal metastases
  • IIA: ≤ 5 nodes, all < 2 cm
  • IIB: > 5 nodes, 2-5 cm
  • IIC: > 5 cm
  • III: supra-diaphragmatic or visceral metastases
25
Q

Stage I seminoma can be managed with ____, ____, and ____

A

Stage I seminoma can be managed with surveillance, adjuvant XRT (20 Gy to para-aortic), and single-dose carboplatin

  • Relapse risk high with surveillance
  • High recurrence-free and and cancer-specific survival with XRT
26
Q

Stage IIA or non-bulky IIb seminoma is managed with ____

A

Stage IIA or non-bulky IIb seminoma is managed with radiation therapy

  • 30-36 Gy
  • Right: interaortocaval, precaval, paracaval, and ipsilateral iliac
  • Left: para-aortic and ipsilateral iliac
27
Q

Bulky stage IIB or stage III seminoma is managed with ____

A

Bulky stage IIB or stage III seminoma is managed with chemotherapy

28
Q

Describe initial NSGCT treatment by stagea

A

Initial NSGCT treatment by stagea

  • Stage I: surveillance, RPLND or chemo in high-risk patients
  • Stage IIA and non-bulky IIB: RPLND for solitary node < 3 cm, chemo for any node > 3 pm
  • Bulky IIB and stage III: chemo
29
Q

NSGCT stage 1 can be managed with surveillance if ____

A

NSGCT stage 1 can be managed with surveillance if normal post-orchiectomy tumor markers

30
Q

Risk factors for recurrence such as ___ drive management decisions for NSGCT

A

Risk factors for recurrence such as lymphovascular invasion drive management decisions for NSGCT

31
Q

Describe complications of chemotherapy

A
32
Q

___ can be used as a diagnostic and therapeutic procedure for stage I NSGCT

A

RPLND can be used as a diagnostic and therapeutic procedure for stage I NSGCT

33
Q

Describe ejaculatory neuroanatomy

A

Ejaculatory neuroanatomy

  • Non-nerve sparing full templates lead to retrograde ejaculation in 95%
  • Antegrade ejaculation requires: one sympathetic chain, ≥ 1 post-sympathetic efferent nerve, and hypogastric plexus
  • Two approaches to optimize antegrade ejaculation: nerve-sparing, modified templates
34
Q

RPLND is associated with ___ survival

A

RPLND is associated with increased survival

35
Q

Describe patterns of retroperitoneal metastases of NSGCT

A

Patterns of retroperitoneal metastases of NSGCT

  • No reliable sentinel node in retroperitoneum
  • Most metastases occur in NSGCT
  • Right sided tumors commonly metastasize to the interoaortocaval region and are capable of right to left RP spread
  • Left sided tumors commonly metastasize to para-aortic with low likelihood to left to right RP spread
36
Q

Cure rate ____ as NSGCT stage increases

A

Cure rate decreases as NSGCT stage increases

37
Q

____ can be used after chemotherapy in NSGCT

A

Surveillance

38
Q

Describe characteristics of late relapse of testis cancer

A

Late relapse of testis cancer

  • > 2 years after initial treatment
  • AFP is predominant tumor marker but tumor markers normal in 25%
  • Yolk sac and teratoma are most common histologies
  • RP and chest are most common site
  • Chemoresistant
  • Manage with surgery
39
Q

Patients with GCTs should be encouraged to ___ prior to initiating treatment

A

Patients with GCTs should be encouraged to sperm bank prior to initiating treatment

40
Q

Leydig and Sertoli cell tumors present with ____ and ____ such as ____, ____, and ____

A

Leydig and Sertoli cell tumors present with palpable mass and abnormalities in testosterone / estrogen secretion such as virilization, gynecomastia, and loss of libido

  • Most benign
  • Surgery is curative but use surveillance of RPLND if clinical stage 1
41
Q

Describe testicular lymphoma

A

Testicular lymphoma

  • Generally seen in older patients (60-80)
  • Most common cause of a testis mass in men > 60 years old
  • Typically presents with diffuse enlargement rather than a discrete mass
  • Infiltrating lymphoma cells between tubules
  • Majority of cases are diffuse large B cell lymphomas
  • Age, tubule sparing, no lymphocytes, and cytology differentiate from seminoma
42
Q

___ are primarily responsible for the blood-testis barrier

A

Sertoli cells are primarily responsible for the blood-testis barrier

43
Q

Significant standalone risk factors for germ cell cancer are ____, ____, and ____

A

Significant standalone risk factors for germ cell cancer are personal / FMHx of GCT, infertility associated with Y chromosome microdeletions, and Klinefelter’s syndrome

44
Q

Half life of LDH ____

A

Half life of LDH can range from 10 hours to 3 days depending on the iso-enzymes expressed by the tumor

45
Q

___ is a testicular tumor characterized by lymphocytic tumor

A

Classic seminoma is a testicular tumor characterized by lymphocytic tumor

46
Q

____ lymph node group is primarily landing spot for right sided testis tumor

A

Interaortocaval lymph node group is primarily landing spot for right sided testis tumor

47
Q

____ is the best treatment option for a patient with mixed GCT of the L testis exhibiting persistently elevated post-orchiectomy tumor markers despite normal CAT scans

A

PEB chemotherapy is the best treatment option for a patient with mixed GCT of the L testis exhibiting persistently elevated post-orchiectomy tumor markers despite normal CAT scans

48
Q

Injury to ____ may contribute to development of anejaculation following a PC-RPLND

A

Injury to hypogastric plexus may contribute to development of anejaculation following a PC-RPLND

49
Q

____ is the most common testicular neoplasm identified in men over age 60

A

Lymphoma is the most common testicular neoplasm identified in men over age 60

Repro / GU (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions