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CL 201 > Tanya (Cervical and testicular cancer) > Flashcards

Tanya (Cervical and testicular cancer) Flashcards

1
Q

What is testicular cancer?

A

Cancer affecting male reproductive organ. Affects the testicles which are responsible for sperm production and testosterone. They are made out of many different cells which can become cancerous. The type of cell that becomes cancerous determines the type of cancer. Testicular cancer has a good prognosis.

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2
Q

Epidemiology of testicular cancer

A

Rare, affects 1 in 190 males. Accounts for 1% of all cancer cases in men. It is the 16th most common cancer in males. 5 year survival rate is 97%.

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3
Q

Aetiology of testicular cancer

A
  • Family history (if father as it- son is 4x more likely to get it, if brother has it- brother is 9x more likely to get it)
    -Cryptorchidism (undescended testicles)
  • Previous testicular cancer
  • Testicular carcinoma in situ (Pre-cancer state)
  • Ethnic background (more common in Caucasians than Asian or African people)
  • HIV
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4
Q

Types of testicular cancer

A
  • Non-germ cell tumour
  • Germ cell tumour
    • Seminoma (B-HCG)
      • classical
      • spermatical
        -Mixed (AFP and B-HCG)
    • Non-seminoma
      • teratoma
      • teratocarcinoma
      • choriocarcinoma
      • embryonal carcinoma (AFP and B-HCG)
      • yolk sac tumour (AFP)
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5
Q

Which type of testicular cancer makes up the majority?

A

Germ cell tumour- makes up 90% of testicular cancer

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6
Q

What age do non-seminoma tumours occur?

A

Usually between teens and 30s

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7
Q

Which sub-type of testicular cancer is most common in children?

A

Yolk sac tumour

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8
Q

What are the signs and symptoms of testicular cancer?

A
  • Testicular limp that is usually painless
  • Lumber back pain
  • Cough and dyspnoea, difficulty swallowing (related to metastasis)
  • CNS symptoms
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9
Q

What is used to make a diagnosis of testicular cancer?

A
  • Ultrasound- to visualise abnormal growths
  • MRI scan
  • Chest X-ray
  • Blood test- AFP, LDH, B-HCG
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10
Q

What are the stages of testicular cancer?

A

Stage 1- tumour confined to testes
Stage 2- tumour spread to abdominal lymph nodes
Stage 3- Tumour spread to lumph nodes above the diaphragm
Stage 4- Tumour invading other organs such as liver or lungs

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11
Q

What is it called when a tumour invades other organs?

A

Metastasis

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12
Q

What are the treatments for testicular cancer?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
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13
Q

What is the treatment of stage 1 testicular cancer?

A

Observation, radiation, chemotherapy (given 4 weekly basis)

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14
Q

What is the treatment of stage 2 testicular cancer?

A

Stage 2a (seminoma) with tumour size <2cm
- radiotherapy
- chemotherapy

Stage 2b (seminoma) with tumour size <5cm
- chemotherapy- cisplatin based regimen

Stages above 2b
- chemotherapy

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15
Q

Why is a combination of treatments used? (testicular cancer)

A

To reduce toxicity and reduce resistance

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16
Q

Why would one treatment be chosen over another? (testicular cancer)

A

They are chosen based on side effects e.g. bleomycin affects the lungs so this would be avoided in athletes

17
Q

Chemotherapy combination regimes (testicular cancer)

A

BEP
- Bleomycin
- Etoposide
- Cisplatin
EP
- Etoposide
- Cisplatin
VIP
- Etoposide
- Ifosfamide
- Cisplatin

18
Q

What is the indication, route of administration and side effects of Bleomycin? (testicular cancer)

A

I- metastatic testicular cancer, Non-Hodgkin’s lymphoma
RoA- intramuscularly
SE- fever, malaise, interstitial pneumonia, nausea and vomiting, pulmonary fibrosis

19
Q

What is the indication, route of administration and side effects of Etoposide? (testicular cancer)

A

I- carcinoma of the bronchus, testicular cancer, lymphoma
RoA- Iv infusion
SE- hypertension, nausea and vomiting, abdominal pain, diarrhoea, fatigue, alopecia, anaemia, leucopenia (reduced WBCs), thrombocytopenia (platelet deficiency)

20
Q

What is the indication, route of administration and side effects of Cisplatin? (testicular cancer)

A

I- testicular cancer, lung cancer, cervical cancer, bladder cancer, head and neck cancer, ovarian cancer
RoA- IV infusion
SE- severe nausea and vomiting, myelosuppression (decrease in bone marrow activity), nephrotoxic (deterioration in kidney function), hearing loss, peripheral neuropathy, hyperurcaemia (high levels of uric acid in blood), anaphylactic reactions

21
Q

What is the indication, route of administration and side effects of Ifosfamide? (testicular cancer)

A

I- testicular cancer
RoA- IV infusion
SE- nephrotoxic, neurotoxic and can cause encephalopathy (brain function is affected), nausea and vomiting, hypersensitivity, haemorrhage cystitis

22
Q

What is cervical cancer?

A

Cancer that starts in the neck of the womb (the cervix)

23
Q

Epidemiology of cervical cancer

A

Accounts for 2% of all cancers. 13th most common cancer amongst women in the UK. 1 in 139 women will be diagnosed with cervical cancer. 5 year survival rate is 67%

24
Q

Aetiology of cervical cancer

A
  • HPV (Human Papilloma Virus)
  • Unprotected sex
  • Chemicals
  • Age (more common in younger women (under 45))
  • Cigarette smoke
  • Social deprivation
  • Multiparity (producing more than 1 at birth)
  • Early onset of sexual intercourse (before age 17)
25
Q

Pathology of cervical cancer

A

Early changes in the cells of the cervix will first be discovered through a smear test. If there is moderate to severe changes the patient will be invited for colposcopy which allows for the grading of abnormal cells and gives an impression of how deeply abnormal cells have gone into skin of the cervix. These changes are classed according to cervical intraepithelial neoplasia (CIN) changes.

26
Q

What are the stages of cervical cancer?

A

Stage 0- carcinoma in situ
Stage 1A- microscopic disease found only in the cervix
Stage 1B- visible disease found only in the cervix
Stage 2A- tumour extends beyond cervix without parametrium involvement (parametrium- separates supravaginal portion of cervix from bladder)
Stage 2B- parametrium involvement
Stage 3A- tumour extends to the pelvic side wall
Stage 3B- tumour extends to the pelvic wall with non-functioning kidney
Stage 4a- tumour extends to adjacent organs
Stage 4B- tumour extends to distant organs (metastasis

27
Q

What are the types of cervical cancer?

A

Squamous cell
Adenocarcinoma
Adeno squamous carcinoma
Small cell cancer

28
Q

What are the signs and symptoms of cervical cancer?

A
  • Unusual bleeding
  • Smelling vaginal discharge
  • Post coital bleeding
  • Backache (advanced disease)
  • Blood in urine
  • Bone pain
  • Weight loss
  • Loss of appetite
  • CIN changes have no symptoms
29
Q

What is the the cervical screening program?

A

It is used to detect abnormal cell growth in the cervix. Involved a smear test (aka liquid based cytology). Women between the ages of 25-49 yrs old are invited every 3 years and women between the ages of 50-64 are invited every 5 years (unless they have an abnormal screen in which case they will be invited back until screen is normal). In younger women changes occur all the time so they are not offered screening to prevent unnecessary treatment.

30
Q

What is the outpatient diagnosis for cervical cancer?

A

GP refer patient to gynaecologist
Gynaecologist repeat initial examination (smear taken)
Colposcopy done prior to admission
Patient admitted to hospital for examination and cervical biopsy
Histological diagnosis
Staging investigations (FBC, chest x-ray, CT or MRI)

31
Q

What are the treatment options for cervical cancer?

A

The treatment depends on the stage of the disease:
Radiotherapy
Chemotherapy
Chemoradiotherapy
Surgery
- cone biopsy
- radical trachelectomy (removal of cervix)
- hysterectomy (removal of cervix and womb)

32
Q

What is the treatment for each stage of cervical cancer?

A

Stage 0- cone biopsy, surgical excision
Stage 1A- hysterectomy, cone biopsy, local excision, radial hysterectomy
Stage 1B and 2A- radical hysterectomy, pelvic lymphadenectomy, pelvic irradiation
Stage 2B and 3- pelvic radiotherapy
Stage 4- chemotherapy (more than 1 chemotherapy ages is used for a synergistic effect)

33
Q

What is the indication, route of administration and side effects of paclitaxel? (cervical cancer)

A

I- breast and cervical cancer
RoA- IV infusion
SE- bone marrow suppression, neurotoxicity, hypersensitivity (requires monitoring after infusion), extravasation (leaking of drug into surrounding tissue which can cause tissue damage e.g. tissue necrosis (tissue death))

34
Q

What is the indication, route of administration and side effects of cisplatin/carboplatin? (cervical cancer)

A

I- testicular cancer, lung cancer, cervical cancer, bladder cancer, head and neck cancer, ovarian cancer
RoA- IV infusion
SE- severe nausea and vomiting, myelosuppression (decrease in bone marrow activity), nephrotoxic (deterioration in kidney function), hearing loss, peripheral neuropathy, hyperurcaemia, anaphylactic reactions

35
Q

What does the patient need to have before treatment of platinum compounds to decrease nephrotoxic side effect?

A

Needs IV hydration. Magnesium levels can be affected so these need to be monitored too.

36
Q

What is the indication, route of administration and side effects of topotecan? (cervical cancer)

A

I- cervical cancer, small cell lung cancer, metastatic ovarian cancer
RoA- IV infusion, oral capsules
SE- diarrhoea, bone marrow suppression, hypersensitivity, sepsis (WBC con drops so increased infection- neutropenic sepsis), alopecia, mucositis (inflammation in the mouth)

37
Q

What is the indication, route of administration and side effects of bevacizumab? (monoclonal antibody treatment) (cervical cancer)

A

I- cervical cancer, metastatic breast cancer, metastatic colorectal cancer, metastatic renal cancer, ovarian cancer
RoA- IV infusion
SE- osteonecrosis of the jaw (needs dental before treatment), fatigue, pain, lack of energy, GI effects
Monitoring- blood pressure as can cause hypertension

CL 201 (35 decks)

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