Testicular Flashcards
Testicular cancer Tumor markers?
beta-hCG - elevated in 10-15% of seminomas
AFP - if elevated, NOT pure seminoma
LDH
Testicular Nodal drainage
Overall, primarily to retroperitoneal region
L testicle -> L para-aortic
L testicular vein into L renal vein first
R testicle - R paracaval, precaval, retrocaval nodes
R testicular vein directly into IVC
Testicular T-staging
T1 - limited to testis (including rete testis invasion WITHOUT LVI)
T1a - <3 cm
T1b - 3+ cm
T2 - limited to testis (including rete testis WITH LVI) OR invading hilar soft tissue/epididymis or penetrating visceral mesothelial layer covering external surface of tunica albuginea with or without LVI
T3 - directly invades spermatic cord soft tissue with or without LVI
T4 - invades scrotum with or without LVI
Testicular N-staging
N1 - 2 cm or smaller, 5 or less nodes positive, none larger than 2 cm
N2 - 2-5 cm or >5 nodes, none larger than 5 cm, OR ENE
N3 - 5+ cm
Testicular S (serum) staging
S0 - WNL
S1 - LDH <1.5x upper limit, hCG <5,000, AFP <1,000
S2 - LDH 1.5-10x UL, hCG 5,000-50,000, AFP 1,000-10,000
S3 - higher
Testicular Prognostic staging
Stage I - All T, N0
Stage II - All N+, S0-1 (A, B, C correspond with N1, 2, 3)
Stage III - M1 OR N+S2/S3
At diagnosis, 85-80% of patients are clinical stage I
Testicular Treatment for seminomas
Stage I - radical inguinal orchiectomy, then active surveillance
If tumor size >3 cm, could consider adjuvant treatment (Carboplatin AUC7 x1 or RT 20 Gy/10)
IIA - 20-25.5 to modified dog-leg field, boost nodes to 30 Gy
IIB - same but boost to 36 Gy; chemo preferred if >3 cm
IIC, III - BEP x4 OR VIP x4
Overall, adjuvant radiation really only standard for IIA, maybe IIB if mass <3 cm
Dog-leg - RP, proximal ipsilateral iliac nodes to bottom or obturator foramen
T11 to top of acetabulum
Testicular Kidney constraints
D50 <8 Gy for each kidney
If solitary kidney, D15 <20 Gy
