Testicular Flashcards
What percentage of all male cancers does testicular cancer account for?
1%
What is the most common age range for testicular cancer?
15-35 years
What is the average age of diagnosis for testicular cancer?
33 years
In which demographic is testicular cancer more common?
Caucasians
What is cryptorchidism?
Undescended testes
90% of patients will not have a history of cryptorchidism.
What condition can increase the chance of testicular cancer?
Atrophy of testes
What is a common symptom of testicular cancer?
Usually appears as painless swelling or a nodular mass in the scrotum.
What sensations might a patient experience in the scrotum or lower abdomen?
Dull ache or heaviness.
What percentage of patients experience acute and severe pain?
10% of patients.
What previous medical history might be relevant for testicular cancer?
Previous trauma.
What is a potential symptom related to gynecomastia in testicular cancer?
Gynecomastia occurs in 5% of patients (germ cell tumors).
What type of tumors can produce HCG?
Germ cell tumors such as choriocarcinoma.
How is testicular cancer often detected?
Often detected by self palpation.
What is the first step in the diagnostic workup for testicular cancer?
H&P
What imaging study is used in the diagnostic workup for testicular cancer?
Ultrasound
Which tumor markers become elevated in non-seminomas?
AFP (Serum Alpha-fetoprotein) and beta hCG (Human Chorionic Gonadotrophin)
What surgical procedure is commonly performed in the treatment of testicular cancer?
Orchiectomy
What imaging studies are performed to check for lymph node involvement and distant metastasis?
CT scan of chest, abdomen, and pelvis
What should be considered for patients whose treatment may compromise fertility?
A semen analysis and sperm banking should be considered for patients who intend to have children in the future.
What is seminoma?
Seminoma is the most common type of testicular cancer and has three subtypes: Classic, Anaplastic, and Spermatocytic.
What are the subtypes of seminoma?
The subtypes of seminoma are Classic, Anaplastic, and Spermatocytic.
Do the prognoses differ among seminoma subtypes?
No, the prognoses are not significantly different for the various subtypes.
What are non-seminoma tumors?
Non-seminoma tumors include Embryonal adenocarcinoma, Teratoma, Choriocarcinoma, and Yolk sac carcinoma (in children).
What are the embryonic tissues involved in testicular cancer?
The embryonic tissues involved are ectoderm, endoderm, and mesoderm.
What is a teratoma?
A teratoma is a type of tumor that can contain different types of tissues.
What is yolk sac carcinoma?
Yolk sac carcinoma is a type of non-seminoma tumor that primarily affects children.
What organizations are involved in staging testicular cancers?
The European Organization for Research on Treatment of Cancer (EORTC) and the International Union Against Cancer (UICC) are involved in staging testicular cancers.
Which staging systems are used for testicular cancers?
AJCC staging systems are used to stage testicular cancers.
What are the anatomical structures related to testicular cancer?
Spermatic Cord, Tunica Vaginalis, Epididymis, Scrotum, and Testis.
What does T2, T3, and T4 represent in testicular cancer staging?
T2, T3, and T4 are classifications used in the staging of testicular cancer.
What is the tendency of pure seminomas regarding spread?
Pure seminomas have a much greater tendency to remain localized or involve only lymph nodes.
How do non-seminomatous germ cell tumors of the testes spread?
Non-seminomatous germ cell tumors may spread via lymphatic or hematogenous routes.
What are the routes of lymphatic spread?
Lymphatic spread occurs in an orderly fashion through paraortic, mediastinal, and supraclavicular regions.
Where can metastasis rarely occur in testicular cancer?
Metastasis can rarely occur in the lung, bone, liver, and brain.
What is the treatment of choice for stage I seminoma?
The most commonly applied treatment is radical orchiectomy and postoperative irradiation of the paradortic or paradortic and ipsilateral pelvic nodes.
What setup, for a female patient, is similar to the setup for treating testicular cancer?
Similar to a vulva setup on a female patient.
What is the positioning and immobilization for the patient?
Patient is supine, frog legged, with leg vac lok. Arms are high on chest or above head.
What is the purpose of the clam shell in testicular cancer simulation?
A scrotal shield is used for the remaining testicle to decrease scattered radiation and preserve fertility.
What is the recommended irradiation area for patients with stage I testicular seminoma?
Patients should receive irradiation to the paraaortic or paraaortic and ipsilateral pelvic lymph nodes.
What is the superior border of the ‘Hockey Stick’ field?
The superior border is approximately 110-111 to ensure treatment of the nodes at the level of the renal hilum.
What is the inferior border of the ‘Hockey Stick’ field?
The inferior border is at the bottom of L5 or the top of the acetabulum, depending on whether pelvic nodes are treated.
What are the lateral borders of the ‘Hockey Stick’ field?
The top lateral border is approximately 10cm wide to include the entire vertebrae, and the bottom is at the edge of the ilium.
What is the significance of Fig. 7.10?
Fig. 7.10 illustrates the testicular treatment field.
What is the T10 reference in radiation borders?
T10 refers to a specific vertebral level used in determining radiation borders.
What is the importance of surgical scars in radiation treatment?
Surgical scars can influence the planning and execution of radiation treatment fields.
What are the two types of fields used in treating the peridortic and ipsilateral inguinal areas?
A hockey stick shaped portal or two abutting periaortic and iliac fields.
What is the advantage of using a single hockey stick portal?
It allows for ease of setup and avoids potential overlap or underdosage that exists when treating two separate ports.
What is used to shape the hockey stick field and protect critical organs?
Custom blocks.
What is the dose for Seminoma?
6-18 MV photons
What areas receive irradiation following surgery for Seminoma?
The periaortic and ipsilateral inguinal iliac areas
What is the tumor dose for irradiation in Seminoma?
25 Gy in 15-17 fractions
What is the total dose for Paradortic Fields in Seminoma treatment?
2000 cGy
What is the total dose for Hockey Stick Field in Seminoma treatment?
2000-2550 cGy
What alternative method may be used in Seminoma treatment?
Electrons to treat one of the testicles or the scar from Orchiectomy
What is the total boost dose to lymph nodes in Seminoma treatment?
3000-3600 cGy
What is the initial treatment for non-seminoma?
Radical Orchiectomy followed by Cisplatin based chemotherapy.
What are some chemotherapy regimens for non-seminoma?
Different chemotherapy regimens include:
1. Cisplatin, Vinblastine, Bleomycin (PVB)
2. Bleomycin, VP-16, Cisplatin (BEP)
3. Etoposide, Cisplatin, Bleomycin
4. Etoposide, Ifosamide.
What organization provides guidelines for non-seminoma treatment?
National Comprehensive Cancer Network (NCCN).
What is the role of radiation in disseminated non-seminoma?
Radiation has little role in the management of patients with disseminated non-seminoma, except in the palliation of brain and other metastatic sites.
What is the main treatment in advanced state of testicular cancer?
Chemotherapy is the main treatment in advanced state.
What are common side effects of radiation?
Nausea, fatigue, diarrhea
Common ailments from radiation near the intestines.
What skin reactions can occur from radiation?
Skin reactions occur only in the treatment area with skin folds.
How does radiation affect fertility?
Decreased fertility and decrease in sperm count.
Spermatogenesis may be affected by doses as low as 50 CGy.
What dose of radiation can cause permanent sterility in males?
Permanent sterility occurs at 15-20 Gy to the scrotum.
What percentage of the prescription dose does the uninvolved testicle receive?
Typically, the uninvolved testicle receives 1% to 2% of the prescription dose due to scattered radiation through body tissues.
How is paraaortic and pelvic radiation generally tolerated?
In general, paraaortic and pelvic radiation is well tolerated.
