Testicular and Bladder Cancer Flashcards
Which of the following is FALSE about testicular cancer?
A. Most common solid tumor in men 20-34 y/o
B. Most are germ cell tumors
C. Cryptorchidism increases risk of testicular cancer
D. Pre-pubertal orchiopexy hasnotshown to decrease risk of cancer
D. It does decrease risk
T/F:Seminomasare radiation sensitive.
True
T/F: Pure seminomas produce alpha fetoprotein (AFP)
False. Theyneverproduce AFP
T/F: Seminomas grow slower than NSGCT
True
NSGCT doubling time = 10-30 days
What are the 3 types of the seminomas?
Typical (classic) - 85%
Anaplastic - 5-10%
Spermatocytic - 2-12%
What type of seminoma?
Seen in older patients
Favorable prognosis
Spermatocytic
What type of seminoma?
Greater metastatic potential
Higher bHCG production
Anaplastic
Seminomas produce ____
beta-human chorionic gonadotropin (bHCG)
What are the 4 types of NSCGT?
Teratoma
Embryonal
Choricarcinoma
Yolk Sac
What type of testicular cancer is NOT chemosensitive?
Teratoma (NSGCT)
What kind of testicular cancer spreads hematogenously?
Choricarcinoma (NSGCT)
What type of testicular cancer is most common in children?
Yolk Sac (NSCGT)
What type of testicular cancer may hemorrhage?
Choricarcinoma
Regional spread nodes in what direction?
Right to left
Right testis spread to ____
interaortocaval area
Left testis spreads to ____
para-aortic area
T/F: Patients typically present with painful enlarged testis.
False.Painless
Alpha-fetoprotein is produced by (2)
Yolk sac tumors (NSGCT) Embryonal cancer (NSGCT)
Human chorionic gonadotropin (hCG) produced by (2)
Choriocarcinoma
15% of seminoma
Best imaging modality to diagnose testicular cancer
Scrotal ultrasound
T/F: Testicular mass biopsy should be performed in order to confirm diagnosis of testicular cancer.
False. NEVER perform a testicular mass biopsyAny solid intratesticular mass is neoplastic until proven otherwise
T/F: Advanced testicular cancer has a high mortality rate due to its rapid progression.
False.
Radiation is used to treat ____
seminoma
Most serious long term SE of chemotherapy
Second malignancy
T/F: Retroperitoneal Lymph Node Dissection (RPLND) causes erectile and ejaculatory problems.
False. No erection problems. Ejaculation problems.
T/F:Retroperitoneal Lymph Node Dissection (RPLND) is an effective treatment of low stage seminoma.
False. Not used b/c seminoma is “sticky”
Low stage seminoma treated w/ adjuvant radiotherapy
High stage seminoma is treated with ____
Cisplatin-based chemotherapy
Stage 1 NSGCT treated with ____
Orchiectomy
Retroperitoneal Lymph Node Dissection (RPLND)
Surveillance
Chemotherapy
What should you do if tumor markers are still elevated after orchiectomy as treatment for NSGCT?
Sign of distant mestastasis –> treat with chemotherapy
High stage NSCGT treated with ____
Chemotherapy
Postchemotherapy residual masses treated w/ RPLND
*Teratoma is NOT responsive to chemotherapy
T/F: Bladder cancer is predominently in old men.
True. Peak age 70-80 y/o
Which of the following is NOT a risk factor of bladder cancer?
A. Smoking
B. Rubber, textile, dye exposure
C. Being a hair dresser
D. Pesticide exposure
E. Chronic cystitis (indwelling catheter)
F. Schistosomiasis
D. Pesticide is NOT a significant risk factor
T/F: Family history is a significant contributor to getting bladder cancer.
False. Only 8% contribution. However RR increases 2x w/ FHx.
Most common histological type of bladder cancer
Urothelial carcinoma (95%) Squamous cell carcinoma (5%)
2004 grading classification of bladder cancer
PUNLMP = papillary urothelial neoplasm of low malignant potential
Low grade
High grade
What stage?
Muscle invasive bladder cancer
T2 = stage of invasion
T/F: Stage T3 bladder cancer is treated by resection of the tumor.
False. T3 has invaded into perivescal fat. Can’t resect into the fat.
T/F: Stage T4bladder cancer is treated by resection of the tumor.
True. T4 = prostatic stromal invasion
Regional lymphatic spread of bladder cancer spreads to _____
pelvic lymph nodes
Advanced disease of bladder cancer spreads to the _____ lymph nodes
retroperitoneal
Most common clinical sign of bladder cancer
Intermittent, gross, painless hematuria (80-90% of cases)
T/F: AUA guideline requires 2 out of 3 positive dipstick tests for hematuria to diganose asymptomatic microhematuria in association with bladder cancer.
False. Require only 1 + UARequring more than 1 lowers cancer detection rate b/c hematuria associated with bladder cancer is highly intermittent.
T/F: Patients with bladder cancer have positive PE findings, including palpable bladder/pelvic mass.
False. PE is normal unless in advanced disease
T/F: Urine cytology is highly sensitive to detecting bladder cancer.
False. Highly specific (ruling inbladder cancer diagnosis)
Best imaging modality for bladder cancer
CT abd/pelvis +/- contrast = CT urogram
Alternative imaging modality for patients who can’tget contrast due to allergy or azotemia
Retrograde pyelogram orMRI
T/F: A positive finding on the CT urogram is diagnostic of bladder cancer.
False. Allcurent imaging studies are inadequate to clear bladder
Gold standard for bladder cancer diagnosis
Cystoscopy (w/ biopsy if necessary)
Treatment of primary bladder tumor
Transurethral resection of bladder tumor (TURBT)
Diagnostic and therapeutic modality for superficial disease Visually confirms diagnosis
Tissue recovery for histology
Ablation of lesion
When shouldrepeat resectionbe performed prior to additional intravesical therapy?
patients w/ lamina propria invasion (T1) but without muscularis propria in specimen
T/F: An intitial single dose of BCG should be administered immediately postoperatively for bladder cancer according to AUA recommendation.
False.Can’t give BCG immediately postop d/t risk of infection and deathHowever, you should give an initial single dose of intravesical chemotherapy.
Indications of intravescical therapy for bladder cancer include all of the following EXCEPT: A. Multiple/rapid recurrence B. Carcinoma in situ C. Stage T2 cancer D. High grade disease
C. NOT for T2 or greater disease.Grade =/= stage
Preferred treatment for muscle invasive bladder cancer
Radical cystectomy (bladder removal) Radical TURBT rarely effective
