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Clin Med III > testicular and prostate cancer > Flashcards

testicular and prostate cancer Flashcards

1
Q

types of testicular cancer

A
  • germ cell make up 95% of cases

- germ cell subdivided into seminomas vs non-seminomatous germ cell tumors (NSGCT)

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2
Q

types of NSGCT

A
  • embryonal cell carcinomas
  • teratomas
  • mixed cell type- most common
  • choriocarcinoma
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3
Q

risk factor for testicular cancer

A
  • hx of cryptorchidism, even if surgically repaired
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4
Q

clinical presentation of testicular cancer

A
  • greatly varied but usu pts wait 3-6 months to seek care
  • painless nodule/ enlargement of testis*
  • heavy sensation
  • acute testicular pain
  • asymptomatic
  • rarely present with gynecomastia
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5
Q

dx of testicular cancer

A
  • scrotal US best initial test
  • if US is suspicious move on to CT (abd-pelvis and chest)
  • serum tumor markers- good for NSGCT
  • radical inguinal orchiectomy +/- retroperitoneal LN dissection (RPLND)
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6
Q

what do seminomas look like on US

A
  • hypoechoic lesions

- no cystic areas

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7
Q

what to NSGCT look like on US

A
  • nonhomogenous
  • calcificatinos
  • cystic areas
  • indistinct margins
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8
Q

serum tumor markers for testicular cancer

A
  • best for NSGCT
  • AFP
  • HCG
  • LDH- good for both types
  • best for f/u of disease or s/p primary treatment
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9
Q

why do pts often get RPLND with testicular cancer

A
  • 44% of time the scan is falsely negative due to micromets

- if pts dont have RPLND have up to 25% relapse in first year

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10
Q

what should all testicular cancer pts be offered before any treatment

A
  • cyropreservation of sperm
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11
Q

stage 0 testicular cancer

A
  • tumor in situ

- abnormal cells but cannot feel mass

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12
Q

stage I testicular cancer

A
  • cancer just in testis
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13
Q

stage II testicular cancer

A
  • cancer in LN

- retroperitoneal or para-aortic LN usually

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14
Q

stage III testicular cancer

A
  • distant mets
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15
Q

treatment for seminomas

A
  • majority present in stage 1 and very rarely metastasize
  • orchiectomy usu curative
  • close f/u
  • if LN involvement add adjuvant XRT or monitor
  • if more extensive LN involvement pts get adjuvant chemo
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16
Q

follow up for seminomas

A
  • get CT esp if initially had RPLN
  • if > 3 cm residual mass -> PET scan -> if pos then resection
  • if < 3 cm mass - surveillance
  • 1-2 mo f/u X 2 years
  • quarterly f/u in 3rd year
  • CXR and CT q 3-4 mo
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17
Q

NSGCT risk factors for relapse

A
  • lymphatic vascular invasion of testicular mass
  • embryonal carcinoma
  • T3 or T4 primary tumor
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18
Q

treatment for NSGCT stage 1

A
  • radical orchiectomy
  • if no RF for relapse then can do close surveillance
  • if 1 or more RF- chemo 1-2 cycles, RPLND
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19
Q

treatment for NSGCT stage 2

A
  • orchiectomy
  • following surgical RPLND + bx or CT findings:
  • < 2 cm= surveillance
  • < 2 cm with 1+ RF= chemo 1-2 cycles
  • > 2 cm and/or elevated tumor markers= chemo 2-3 cycles
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20
Q

management for advanced testicular cancer

A
  • same for seminomas vs NSGCT

- based on good, intermed, or poor risk status

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21
Q

good risk for advanced testicular cancer

A
  • seminomas with just lung mets
  • NSGCT with just lung mets or low tumor markers
  • treatment= chemo X 3 cycles
22
Q

intermed or poor risk for advanced testicular cancer

A
  • seminomas- spread beyond lungs
  • NSGCT- spread beyond lungs, tumor markers either intermed or high
  • treatment= chemo X 4 cycles
23
Q

when does relapse usually occur for testicular cancer

A
  • within first 1-2 years
24
Q

treatment for relapse of testicular cancer in chemo naive

A
  • BEP chemo
25
Q

treatment for relapse of testicular cancer with chemo and orchiectomy

A
  • VIP chemo instead of BEP
26
Q

treatment for relapse of testicular cancer within first 4 weeks

A
  • considered chemo/ platinum refractory

- requires high does chemo

27
Q

treatment for relapse of testicular cancer after 2 years

A
  • uncommon

- require aggressive surgical approach and systemic chemo

28
Q

prostate cancer

A
  • 2nd most common male cancer
  • increased incidence with age
  • most are adenocarcinomas
29
Q

where do most prostate cancers occur

A
  • peripheral zone
30
Q

risk factors for prostate cancer

A
  • AA race
  • high dietary fat
  • family hx
31
Q

clinical presentation of prostate cancer

A
  • most are asymptomatic*
  • may have lower UT sx
  • hematuria/ hematospermia
  • DRE- nodular, asymmetric, indurated
  • boney pain
  • LE lymphedema
  • BOO
  • adenopathy
  • weight loss
32
Q

screening for prostate cancer

A
  • PSA

- DRE

33
Q

PSA

A
  • correlates with volume of prostate, benign or malignant
  • useful for detecting and staging ca, monitoring response to tx, detecting recurrence
  • not specific
  • increases with age
  • monitor fractioned PSA
  • consider PSA velocity- how fast it is changing
34
Q

what is an elevated PSA

A
  • > 4
35
Q

what is fractioned PSA

A
  • % free PSA relative to total PSA
  • more free PSA the better
  • if > 30% ratio low likelihood ca
  • if < 10% ratio higher risk ca
36
Q

diagnosis of prostate ca

A
  • elevated PSA or abnormal DRE -> TRUS bx
  • MRI good for staging
  • bone scan if PSA > 10- 20
37
Q

transrectal US (TRUS) guided biopsy

A
  • get at least 10 biopsies, sometimes up to 18
  • assoc with improved detection of prostate Ca and risk stratification
  • if persistently elevated PSA but neg bx may . need to repeat bx 1-2 X
38
Q

gleason staging

A
  • used for staging, treatment and prognosis of prostate ca
  • 2 samples from largest areas of abnormalities (primary and secondary grades)
  • each rated on a scale of 1-5, total of 2-10
39
Q

stage I prostate cancer

A
  • cant palpate tumor

- found only on bx

40
Q

stage II prostate cancer

A
  • tumor just in prostate
41
Q

stage III prostate cancer

A
  • tumor goes into seminal vesicles or penetrates capsule

- doesnt go into any other adjacent structures

42
Q

stage IV prostate cancer

A
  • penetrates through capsule and spreads elsewhere
43
Q

standard treatment for prostate cancer

A
  • based on pts life expectancy and risk stratification
  • active surveillance/ watchful waiting
  • radical prostatectomy +/- pelvic LN dissection
  • XRT- very effective
  • hormone therapy- palliative care
44
Q

types of XRT for prostate cancer

A
  • external beam radiation therapy (EBRT)

- brachytherapy- direct implant of radioactive source in prostate

45
Q

what is the treatment for most pts with metastatic prostate cancer

A
  • androgen deprivation therapy (ADT)
  • used as palliative measure, not curative
  • may also receive XRT, TURP for BOO, or chemo
46
Q

where are most prostate cancer mets found

A
  • axial skeleton
47
Q

drug classes for ADT

A
  • GnRH agonists
  • LHRH antagonists
  • complete androgen blockade
  • non-steroidal anti-androgens
  • bisphosphonates
48
Q

GnRH agonists

A
  • preferred initial ADT medication
  • initially testosterone increases in first 3 weeks (flare) -> feedback sys shuts down and no more testosterone made
  • leuprolide
  • goserelin
  • histarelin
  • triptorelin
49
Q

LHRH antagonists

A
  • directly inhibits testosterone production
  • no flare effect
  • degarelix
50
Q

complete androgen blockade

A
  • combined GnRH + anti-androgen therapy
51
Q

why give bisphosphonates for prostate ca

A
  • prevents osteoporosis

- helps with bone pain due to mets

52
Q

what are the nomograms used for prognosis of prostate ca

A
  • kattan nomogram

- CAPRA nomogram

Clin Med III (26 decks)

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