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GU > Testes > Flashcards

Testes Flashcards

1
Q

RP tumor in male 15-35

A

assume testis origin

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2
Q

workup of tumor for germ cell tumor men

A

CT AP, CXR, US bilateral, AFP, HCG, LDH; if non-seminoma, then CT chest. You do NOT need PET/brain MRI. get brain MRI if very high bHCG

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3
Q

not needed workup of testis

A

PET/CT

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4
Q

AFP

A

only embryonal or yolk sac, NOT seminoma

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5
Q

HCG

A

seminoma (15%), embryonal, choriocarcinoma

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6
Q

teratoma markers

A

NO markers

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7
Q

AFP half life

A

5-7 days

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8
Q

HCG half life

A

1-3 days

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9
Q

R testis landing zone

A

between IVC and aorta- interaortacaval (R in between)

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10
Q

L testis landing zone

A

lateral to aorta- para-aortic (L stands on own)

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11
Q

landing zone nodes

A

if 5-10mm-50%; 10-15 70%; 15-20 90% likely disease

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12
Q

herniorraphy, orchiopexy

A

need to look more broadly in pelvis for mets because of altered anatomy

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13
Q

seminoma: intermediat risk

A

non-pulm mets; all others low risk

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14
Q

seminoma

A

don’t worry about markers for staging

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15
Q

nonseminoma good risk

A

low markers, no non-pulm mets

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16
Q

nonseminoma poor risk

A

S3 markers, nonpulm mets, or primary mediastinal

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17
Q

S1 POST-ORCHIECTOMY

A

HCG<1000

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18
Q

S2 POST-ORCHIECTOMY

A

HCG 5-50k, AFP 1-10,000; LDH 1.5-10ULN “1k,1.5x,5k”

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19
Q

S3 POST-ORCHIECTOMY

A

> 10ULN LDH; HCG>50k, AFP>10k “10k:10x:50k”

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20
Q

first line-Tx

A

cis/etop +/- bleomycin

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21
Q

favorable response

A

CR or PR with negative markers (PR means major shrinkage with normal markers)

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22
Q

if markers elevated post-orchiectomy

A

needs chemo, have systemic disease

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23
Q

chemo for good risk

A

BEPx3 (Indiana) or EPx4 (MSK)

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24
Q

reduced chemo

A

worse survival, not reduced CR rate

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25
Q

etoposide dose

A

500

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26
Q

cisplatin dose

A

100

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27
Q

fair dose mods

A

delay 1 week for neutropenia; or no VP16 on day 5 if WBCt reduce dose!

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28
Q

Toxicities with BEP3 or EP4

A

BEP3 worse, more neurologic

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29
Q

carbo instead of cis?

A

NO inferior! 72% v 92% survival

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30
Q

intermediate and poor risk disease

A

BEPx4 OR (BEPx2 and HD-CEC x 2) or VIPx4; cure rate 45-70% with surgery

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31
Q

absolute refractory disease

A

very rare, incurable

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32
Q

favorable prognosis in second line

A

prior CR/favorable response >6months

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33
Q

unfavorable relapse

A

mediastinal relapse, prior CR<6mo, extragonadal primary

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34
Q

salvage approach second line favorable group

A

VeIPx4 v. TIPx4

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35
Q

unfavorable group second line salvage

A

TI–>HD-CE or VIP–>HD-CE

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36
Q

salvage therapy cure rate

A

65-70% cure rate; if late relapse/mediastinal/ovarian–>, low 20% cure rate unfavorable 50-60% cure;

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37
Q

after salvage do you need surgery

A

yes! you will find teratoma in 50%, viable germ cell in 30%

38
Q

germ cell tumor primary

A

2% will have bilateral, need both ultrasound

39
Q

scrotal orchiectomy

A

not indicated- predisposes to mets, leaves inguinal spermaticord in place

40
Q

seminomas markers

A

15% make hCG, NEVER AFP

41
Q

embryonal carcinoma

A

hCG and AFP

42
Q

AFP half life

A

marker 5-7 d

43
Q

HcG

A

marker 1-3 day

44
Q

teratoma

A

no markers

45
Q

york sac tumor

A

AFP

46
Q

choriocarcinoma

A

only hcg

47
Q

R testis landing zone

A

between IVC and aorta (in between IVC and sorta

48
Q

L testis tumor landing zone

A

para-aortic space L testis (L of aorta)

49
Q

landmark landing zone likelihood of disease for germ cell tumors

A

5-10mm node–>50% have disease, 10-150–> 70% have disease. important for deciding whether to do RP dissection after chemo in non-seminoma.

50
Q

seminoma risk strata

A

good risk- no Non-Pulm mets; intermediate risk- non-pulmonary mets.

51
Q

toxicities of good-risk regimens for germ cell (BEPx3, EPx4)

A

more toxicity in BEP3- neurologic, and dermatologic

52
Q

CS 1-S and CS-2A with elevated/rising AFP/HCG

A

do chemo first.

53
Q

seminomas >3cm

A

give chemo BEP3/EP4, NOT RT

54
Q

CS 2A and CS2B seminoma <3cm

A

RT acceptable or EP4/BEP3

55
Q

germ cell tumor: carbo v. cis, and dose

A

DO NOT USE CARBOPLATIN; DO NOT DOSE REDUCE either platinum or etoposide! you can delay a week if needed

56
Q

intermediate and poor risk GCT

A

adding high dose chemotherapy is not necessary. you can give either BEP4 or VIPx4 (VIP has more tox- etoposide, ifosfamide,cisplatin)

57
Q

good risk GCT prognsosis,

A

> 90% with surgery, inter/high 70%

58
Q

first salvage chemo for GCT

A

VeIPx4 (vinblastine, ifos, cis), TIPx4, or standard chemo x 2–>high dose carbo/etop x 2

59
Q

3 groups of GCT in salvage setting: favorable prognosis (testis/RP primary, >6months CR before relapse)

A

can cure 60-80% with VeIPx4, TIP4 or high dose therapy with TICE (high-dose

60
Q

salvage GCT- unfavorable prognosis- late relapse , prior CR

A

give TICE (high dose).taxol, ifos, carbo, etop. 50-60% cured

61
Q

salvage GCT- absolute refractory in untreated patients

A

these pts are incurable with high dose therapy, just palliate

62
Q

surgery in germ cell tumors (non-seminomas)

A

pts ALL need surgery to ensure that there is no recurrence

63
Q

i12 or 12p amplification

A

on 100% of germ cell tumors.

64
Q

primary teratomas of testis

A

ALWAYS has malignant potential, over 50% met

65
Q

if residual nodes are >1cm following chemo with GCT

A

NEED RPLND

66
Q

if no RP at chemo start with GCT

A

no RPLND

67
Q

if RP node <1cm following chemo with GCT

A

MSKCC-RPLND, indiana, leave in place and monitor

68
Q

late relapses with GCT

A

> 2 years. mostly probable of failure to control abdomen. cure rate is lower

69
Q

growing teratoma syndrome

A

resect and continue chemo. common.

70
Q

PET/CT in GCT?

A

valuable tool only for pure seminoma, but lots of false positive

71
Q

seminoma RP dissections?

A

not done. give chemo. if >3cm residual, PET can be done, then resect if positive.

72
Q

bleomycin tox

A

reynaud’s, pulm

73
Q

BEP tox

A

MI (7x risk, similar to hodgkin’s) 6x

74
Q

genetics of germ cell tumors

A

iso(12) or amp of 12p–> CCND2, SOX5, JAW1, KRAS

75
Q

surgery for testicular

A

radical inguinal orichectomy, ligate spermatic cord at internal ring

76
Q

markers of seminoma

A

+PLAP, c-Kit, OCT-4, SALL4, -CK, -CD30

77
Q

markers of embryonal ca

A

CK+, CD30+ OCT-4+ SALL4+

78
Q

yolk sac tumor

A

+CK, +AFP +SALL4, -CD117(ckit), - CD30

79
Q

invasion into epidydimis/spermatic cord

A

could result in iliac LN involvment

80
Q

scrotal invasion

A

inguinal LN

81
Q

Tx stage 1 seminoma

A

i.e. LN-neg. observe. may consider para-aortic RT (morbidity tho) or 1 dose carbo.

82
Q

Tx stage IIA seminoma

A
83
Q

Tx stage IIB seminoma

A

> 5LNs or 2-5cm. RT or chemotherapy (EP x 4 or BEP x 3)

84
Q

Tx stage IIC-and up seminoma

A

good risk tx with EP x 3, if >3cm mass and normal tumor marker, get PET/CT >6wk, and surgery if positive. other wise observe

85
Q

bleo dose

A

30KU x 3= 90KU per cycle

86
Q

intermediate risk chemo

A

BEPx4

87
Q

high risk nonseminoma chemo

A

BEPx4. some studies show possible improvement of adding high dose if slow decline in tumor markers

88
Q

excess 12p material

A

correlates with response to cisplatin

89
Q

stage Ib non-seminoma treatment

A

i.e. -LN but at least 1 high risk feature, but no markers after orchiectomy–> surveillance OR RPLND, adjuvant chemo IF stage II pathologically

90
Q

stage IIA nonseminoma treatment

A

i.e. RPLND and surveillence

91
Q

stage IIB nonseminoma treatment

A

i.e. >5LN or 2-5cm–> RPLND and 2 cycles chemo. if looks like 2B before surgery, give primary chemo.

92
Q

stage IIIC non-seminoma treatment

A

i.e. >5cm. primary chemo. if incidental on RPLND, then give 3-4 cycles adjuvant chemo.

GU (4 decks)

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