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Clin Med 3 > Testicular and Prostate Cancer - Exam 2 > Flashcards

Testicular and Prostate Cancer - Exam 2 Flashcards

1
Q

what is the most common solid malignancy in men 15-35 y/o?

A

testicular malignancy

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2
Q

right or left side is more common for testicular malignancy?

A

right side

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3
Q

what tumors comprise most primary testicular tumors?

A

Germ cell tumors

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4
Q

what tumors are germ cell tumors and which one is most common?

A

nonseminomatous (M/C)

seminomas

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5
Q

what is the M/C risk factor for testicular cancer?

A

cryptorchidism

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6
Q

what is the M/C presenting sx of testicular cancer?

A

painless nodule/enlargement of testis

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7
Q

signs and sx’s of metastatic testicular cancer?

A

back pain, bone pain, gynecomastia

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8
Q

what does an abnormal teste look like/feel like on PE?

A

firm, hard, fixed area

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9
Q

what should put you on high alert for testicular cancer?

A

cryptorchidism or evidence of orchiopexy (scar from tx for cryptorchidism) -> HIGH RISK FOR TESTICULAR CANCER!!!

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10
Q

what is the initial dx test ordered for testicular cancer? if it’s abnormal, then follow-up with what?

A

scrotal U/S

if abnormal, follow up with CT and serum markers

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11
Q

what do seminomas and non-seminomas look like on scrotal U/S?

A

Seminomas
-hypoechoic lesion w/o cystic area

Non-seminomas
-not homogenous w/ calcifications, cystic areas, indistinct margins

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12
Q

what CT do you order if abnormal US for testicular cancer?

A

abd, pelvis, and chest CT b/c evaluating disease and looking for mets

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13
Q

what are the serum tumor markers for testicular cancer?

A

alpha-fetoprotein (AFP)

HCG (elevated in non-semi)

LDH (elevated in both non-semi and semi’s)

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14
Q

when is alpha-fetoprotein serum tumor marker elevated and not elevated in testicular cancer?

A

elevated in Non-seminomas

NEVER elevated w/ seminomas

AFP = PATHOGNOMONIC FOR NON-SEMINOMAS

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15
Q

what is pathognomonic for non-seminomas?

A

elevated AFP

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16
Q

what is the initial intervention and the best intervention for testicular cancer? when is it done?

A

orchiectomy

done after US, serum biomarkers, and CT are done

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17
Q

is bx of contralateral taste recommended in the US when do orchiectomy?

A

NO!!!

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18
Q

what is the gold standard for staging for retroperitoneum mets in non-seminomas testicular cancer?

A

retroperitoneal LN dissection

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19
Q

what type of testicular cancer has highest risk of nodal involvement?

A

non-seminomas

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20
Q

when is retroperitoneal LN dissection done?

A

during orchiectomy

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21
Q

what is offered to pts with testicular cancer before tx?

A

cryopreservation of sperm

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22
Q

seminomas are what? (mnemonic from book)

A

simple (lak tumor markers)

sensitive (to radiation)

slower growing

stepwise spread

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23
Q

stage 1 seminoma tx?

A

stage 1 = CA in testes only

ORCHIECTOMY = TX

also do, active surveillance, 1-2 cycles of adjuvant chemo w/ carboplatin, or adjuvant retroperitoneal XRT (if not chemo candidate)

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24
Q

Stage 2a seminoma tx?

A

<2 cm involves LN’s

ADJUVANT XRT = TX

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25
Q

Stage 2b seminoma tx?

A

stage 2b = 2-5cm LN’s or c >5cm LN’s

BEP (BLEOMYCIN, ETOPOSIDE, CISPLATIN) = TX

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26
Q

post-treatment of seminoma?

A

CT (Esp if initially had RP)

1-2 months f/u w/ clinician for 2 years and quarterly the 3rd year w/ tumor markers at each check up

CXR and CT every 2-4 months

27
Q

if do CT post-treatment for seminoma and see >3cm residual mass, what do you do?

A

PET scan and if positive then do RP LN resection

28
Q

if do CT post-treatment for seminoma and see < 3cm residual mass, what do you do?

A

surveillance

29
Q

what do you start with for tx of non-seminoma?

A

radical orchiectomy - this determines histology and tx plan

30
Q

stage 1 non-seminoma tx depends on?

A

tx depends on relapse risk factors:
-lymphatic vascular invasion of testicular mass

  • embryonal carcinoma histologic predominance
  • T3 (tumor in spermatic cord) or T4 (tumor in scrotum) primary tumor
31
Q

stage 1 non-seminoma tx if no risk factors?

A

surveillance

32
Q

stage 1 non-seminoma tx if 1 or more risk factors?

A

high risk disease

do active surveillance and treat with chemo (1-2 cycles BEP) and RPLND

33
Q

stage 2 non-seminoma tx?

A

basically if there are < 2cm LN’s and normal tumor markers -> do surveillance and do RPLND if CT found RP LN’s 1-2cm

if >2cm LN and normal tumor markers do 2 cycles of BEP chemotherapy

if CT found >2cm LN and/or elevated tumor markers then do 3 cycles of chemo BEP 3

34
Q

best surveillance of non-seminoma is with what?

A

AFP and HCG serum markers

35
Q

if pt has relapse of testicular cancer and are chemo naive, how do you treat?

A

give BEP chemo

36
Q

if pt has relapse of testicular cancer and aren’t chemo naive, how do you treat?

A

use different chemotherapy -> VIP (vincristine, ifosfamide, cisplatin)

37
Q

incidence of prostate cancer cancer increases with?

A

age b/c it is a hormonally dependent cancer

38
Q

risk factors for prostate cancer?

A

AA race, high fat diet, family hx

39
Q

most prostate cancers are what type of cells and originate where in the prostate?

A

most are adenocarcinomas and originate in the peripheral zone of the gland

40
Q

sx’s of prostate cancer?

A

MOST HAVE NO SX’S

do DRE starting at 50 y/o and detect mass in posterior/lateral aspect of the gland

BONEY PAIN!!! -> BACK PAIN!!!

WEIGHT LOSS

41
Q

where is the most common place for mets for prostate cancer?

A

mets most commonly occur in axial skeleton in prostate cancer -> GET BACK PAIN AS SX!!!

42
Q

what does the new recommendation for screening for prostate cancer say?

A

don’t do screening in asymptomatic men

43
Q

screening tests for prostate cancer?

A

DRE

PSA (prostate specific antigen) - can be misleading b/c not specific to prostate cancer (can be elevated in BPH, prostatitis, etc.)

44
Q

dx of prostate cancer?

A

elevated PSA (≥ 2.6) or abnormal DRE

TRUS (transrectal U/S guided) bx of the prostate

45
Q

what is TRUS for prostate cancer dx?

A

transrectal U/S guided bx of the prostate

done for dx of prostate cancer

GET AT LEAST 10 BX VARIOUS PARTS OF THE PROSTATE (apex, mid-portion, base)

46
Q

if persistently elevated PSA level but neg TRUS bx for prostate cancer, then do what?

A

repeat bx 1-2x and include transition zone this time

47
Q

dx imaging for prostate cancer?

A

MRI of abdomen and pelvis

99-Technetium bone scan

48
Q

MRI for dx of prostate cancer better to stage cancer than what?

A

MRI of abdomen and pelvis are better for staging for prostate cancer than TRUS

49
Q

what is 99-Technetium bone scan for dx of prostate cancer detect? when is it indicated?

A

looks for mets to the axial skeleton b/c that is that main place for mets in prostate cancer

indicated when PSA >10-20

50
Q

what factors warrant imaging for prostate cancer (since you don’t image everyone)?

A

presence of PSA levels >10, high grade histology (Gleason score ≥7, or physical findings that suggest stage T3

51
Q

imaging for stage 2A and below for prostate cancer?

A

NO!!!

52
Q

Gleason staging for prostate cancer based off of what?

A

bx samples (histology)

53
Q

scale range for Gleason staging? score range?

A

scale range: 1-5
-1 is the least worrisome histology and 5 is the most aggressive histology

score range: 2-10 score

54
Q

score of 2-6 in Gleason staging indicates?

A

low-grade or well differentiated tumor

55
Q

score of 7 in Gleason staging indicates?

A

moderate-grade or moderately differentiated tumor

56
Q

score of 8-10 in Gleason staging indicates?

A

high-grade or poorly differentiated tumor

57
Q

why are the scores of Gleason so important?

A

b/c correlates tumor volume, pathologic stage, and prognosis

58
Q

localized disease tx for prostate cancer (low risk disease)

A

active surveillance:

  • PSA no more often than every 6 months
  • DRE no more often than every 12 months
  • repeat prostate bx no more often than every 12 months

radiation therapy

prostatectomy

59
Q

localized disease tx for prostate cancer (intermediate risk disease)

A

radiation therapy

  • ERBT (+/- androgen deprivation therapy 4-6 months)
  • Brachytherapy
  • Combo of ERBT and Brachytherapy

Prostatectomy w/ pelvic LN dissection

60
Q

localized disease tx for prostate cancer (high risk disease)

A
  • ERBT + ADT (2-3yrs)
  • ERBT + Brachytherapy + ADT 1 yr
  • Prostatectomy w/ pelvic LN dissection -> Consider radiatiotherapy
61
Q

what are the C/I’s to brachytherapy for prostate cancer tx?

A

large volume gland, chronic diarrhea or active inflammatory disease of rectum, marked voiding symptoms

62
Q

what is the preferred initial tx for metastatic prostate cancer?

A

Hormone Therapy
-GnRH agonist -> Leuproide

-this med can cause temporary testosterone flare for 3wks-3months -> if worried about flare use Degarelix (LHRH antagonist)

63
Q

when do you use bisphosphonates for prostate cancer tx?

A

in metastatic disease

-use with androgen deprivation to prevent osteoporosis

64
Q

when do you use complete androgen blockade for metastatic stage prostate cancer?

A

if there is bony pain, BOO, flare

add CAB to tx for these reasons

Clin Med 3 (21 decks)

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