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MOHD Keystone exam 3 > Testicuar Cancer > Flashcards

Testicuar Cancer Flashcards

1
Q

chemotherapy associated with pulmonary fibrosis

A

bleomycin from BEP (bleomycin, etoposide, platinol)

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2
Q

chemo alternate to bleomycin

A

ifosfamide

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3
Q

most common solid tumor in men 20-34 y.o.

A

testicular cancer

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4
Q

accounts for 90-95% of testis cancers

A

Germ Cell tumors

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5
Q

two types of testicular germ cell tumors

A
  1. seminoma
  2. nonseminoma (NSGCT)
    * germ cells are pleuripotentia
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6
Q

5-10% testicular cancers

A
  • Leydig cell tumors
  • Sertoli cell tumors
  • Gonadoblastoma
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7
Q

cryptorchidism

A

undescended testis; risk factor for testicular cancer (3-14x^)

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8
Q

orchidopexy

A

placing testis in the scrotum; does decrease risk of testis cancer if pre-pubertal orchiopexy

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9
Q

histologic classification of germ cell tumors

A
  1. seminoma

2. NSGCT (teratoma, embryonal, choriocarcinoma, yolk sac)

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10
Q

the most rare germ cell tumor

A

yolk sac

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11
Q

5-10% of germ cell tumors

A

teratoma

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12
Q

S TECY

A

seminoma; teratoma; embyronal; choriocarcinoma; yolk sac

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13
Q

most common type of seminoma found in older (>50 y.o.) male

A

spermatocytic

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14
Q

prognosis of spermatocytic seminoma

A

favorable

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15
Q

seminoma with high bHCG production

A

anaplastic seminoma (30-36% bHCG production)

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16
Q

seminoma that is radiation sensitive

A

typical (classic)

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17
Q

T or F: bHCG and AFP are biomarkers of pure seminomas

A

false: pure seminomas never make AFP; (means some element of the tumor is NSGCT if AFP is present)

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18
Q

types of seminomas (3)

A
  1. typical = classic (85%)
  2. anaplastic (5-10%)
  3. Spermatocytic (2-12%)
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19
Q

NSGCT that is NOT chemosensitive

A

teratoma

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20
Q

tumor with >1 germ cell layer

A

teratoma (NSGCT)

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21
Q

invades tunica and cord structures

A

embryonal NSGCT

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22
Q

if >40% of tumor is ______, = a risk factor for nodal disease (very aggressive); a)teratoma, b)embryonal, c)chroiocarcinoma, d)yolk sac

A

embryonal

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23
Q

spreads hematogenously, not via LNs

A

pure chorio mets

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24
Q

most common testis tumor in kids

A

yolk sac tumor

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25
Q

barrier to local growth of testicular tumor

A

tunica albuginea

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26
Q

incision for radical orchiectomy

A

inguinal (to prevent iatrogenic scrotal violation which may lead to inguinal mets)

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27
Q

regional lymphatic spread is typically to:

A

retroperitoneal lymph nodes

28
Q

right teste ‘landing zone’ and cross-over mets

A

interaortocaval area; can met to L retroperitoneum

29
Q

left teste ‘landing zone’ and cross-over mets

A

para-aortic area; does NOT typically cross-over to R

30
Q

spread hematogenously with early mets to lung

A

choriocarcinoma

31
Q

____% of NSGCT present with metastatic disease

A

50%

32
Q

most common clinical symptom of testicular cancer

A

painless enlargement of testis (acute pain/swelling in 10%)

33
Q

differential for abdominal pain in young man

A

TESTICULAR CANCER, appendicitis, etc.

34
Q

differential for retroperitoneal mass

A

TESTICULAR CANCER, lymphoma, etc.

35
Q

physical exam for suspected testicular cancer

A

testicular exam (firm, nontender, rock hard mass); abdominal exam (retroperitoneal LNs); distant adenopathy (supraclavicular, inguinal, axillary); gynecomastia (5%)

36
Q

produced by yolk sac tumors and embyronal cancers (NSGCT)

A

AFP (NEVER in seminomas)

37
Q

choriocarcinoma and 15% of seminomas produce:

A

choriocarcinoma

38
Q

reflects tumor burden

A

LDH

39
Q

Other labs to get in suspected testicular tumor

A

CBC (anemia), creatinine (renal failure); LFTs

40
Q

tumor markers to measure in suspected testicular cancer

A

AFP, hCG, LDH, CBC/Cr/LFTs

41
Q

confirms testicular mass and intra- vs extra-testicular

A

scrotal ultrasound

42
Q

ALWAYS get this imaging before OR for orchiectomy

A

scrotal ultrasound

43
Q

additional imaging for suspicious testicular mass

A

CXR - mets to lungs?; abdominal and pelvic CT (mets or retroperitoneal LN involvement)

44
Q

pure seminoma histolgy, AFP negative, elevated b-hCG

A

pure seminoma tumor

45
Q

mixed seminoma/nonseminoma tumors and seminoma histology, elevated AFP

A

NSGCT

46
Q

T or F: treatment of primary tumor involves the following:

  1. testicular mass biopsy
  2. radical inguinal orchiectomy +/- testicular prosthesis
A

FALSE: treatment of primary tumor involves radical inguinal orchiectomy, NEVER testicular mass biopsy

47
Q

treatment options for testicular tumor:

A

surveillance, chemo, radiation, surgery (RPLND)

48
Q

mortality for advanced disease testicular cancer:

A

50% in 70s)

49
Q

side effect of this chemotherapy includes renal insufficiency

A

etopside and cisplatin

50
Q

side effect involves neuropathy, 35% ototoxicity, N/V

A

cisplatin

51
Q

side effect of hemorrhagic cystitis

A

ifosfamide

52
Q

side effects include renal insuff, myelosupression, alopecia, secondary leukemia

A

etopside

53
Q

indications for radiation therapy

A

seminoma tumor (Not used for NSGCT); 26 Gy

54
Q

most serious long-term side effects of chemo:

A

development of second malignancies

55
Q

indication for complete bilateral RPLND

A

suspicious lymph node

56
Q

RPLND may lead to 1) erectile problems, 2) ejaculation problems 3) both

A

ejaculation problems (sympathetic nerves may be injured in RPLND); erections are not an issue because nerves are near prostate

57
Q

primary treatment for seminoma:

A

radiation

58
Q

salvage therapy for seminoma

A

chemotherapy

59
Q

“sticky” tumor in which RPLND is not indicated

A

seminoma

60
Q

high stage seminoma (IIB, IIC, III) treatment:

A

chemotherapy: BEP (bleomycin, etoposide, cisplatin); 90% response

61
Q

treatment for low stage NSGCT

A

Stage I: RPLND, surveillance, chemo; 75% stage 1 cured with orchiectomy

62
Q

RF for microscopic mets in NSGCT

A

> 40% embryonal component; lymphovascular invasion; T2

63
Q

Growing teratoma syndrome

A

teratomas are not chemosensitive; NSGCT continues growing despite chemo

64
Q

most common age group for testis cancer

A

young men

65
Q

young man with scrotal and abdominal pain

A

think TESTICULAR CANCER

66
Q

cure rates for testicular cancer

A

HIGH - many cases are localized at diagnosis; if regional or distant disease, are often responsive to multimodal thearpy

MOHD Keystone exam 3 (9 decks)

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