Testicular and Prostate Malignancy Flashcards
What are most primary testicular tumors
germ cell tumors
What are the two categories germ cell tumors are broken into
nonseminomatous
seminomas
What are the other type of less common testicular tumors
sex cord stromal tumors
What types of caners are nonseminomatous
- embryonic cell carcinoma
- teratoma
- mixed cell type
- choriocarcinoma
What types of cancers are sex cord stromal tumors
- leydig tumor
- sertoli cell tumor
- granulosa cell tumor
What is a risk factor for testicular cancer
cryptorchism
Which side is testicular cancer more common on
right
How do patients with testicular cancer present
- painless nodule/enlargement of the testis
- heavy sensation or dull ache
Diagnostic for testicular cancer
- scrotal US
- CT
- serum tumor marker testing
- retroperitoneal LN dissection
- radical inguinal orchiectomy
Seminoma on US
hypoechoic lesion without cystic area
Non seminomatous germ cell tumors on US
not homogenous w/ calcifications, cystic areas, indinstinct margins
What finding on US would make you think it wasnt a malignancy
cystic or fluid filled mass
What serum markers are done for testicular cancer
-alpha fetoprotein
-beta human chorionic gonadotropin
lactate dehydrogenase
Where does regional metastases occur first with testicular cancer
retroperitoneal lymph nodes
When is an orchiectomy and RPLND done
- initial evaluation
- definitive histologic evaluation
- primary local tumor control
What is the gold standard for staging of the retroperitoneum
RPLND
What type of testicular cancer do you have to do a RPLND with? Why?
NSGCT becasue it has a high risk of nodal involvement
Diagnosis and initial tx of seminoma
radical orchiectomy
Do seminomas show elevated tumor markers
no
Stage 1 seminoma tx
- orchiectomy typically curative
- adjuvant chemo (carboplatin)
- radiation if not candidate for chemo
Tx for stage 2a seminoma
-orchiectomy with adjuvent XRT
What makes a seminoma stage 2A? 2b? 2c?
2a- <2cm involved LN
2b- 2-5 cm LN
2c- >5cm LN
Tx for stage 2b seminoma
orchiectomy with adjuvant chemo
If there is a seminoma with an elevated B-HCG what would you add to the tx
adjuvant cisplatin chemo
What needs to be done post-treatment of a seminoma
- CT (if LN involvement)
- 1 to 2 month follow up for 2 years then every 3 months for one year
- tumor markers at each visit
- CXR and CT every 3 to 4 months
What does the tx of stage 1 NSGCT depend on
relapse risk factors
What are the relapse risk factors for NSGCT
- lymphatic vascular invasion of testicular mass
- embryonal carcinoma
- T3 or T4 primary tumor
If there are no risk factors how would you treat stage 1 NSGCT
surveillance after orchiectomy
If risk factors are present in stage 1 NSGCT how would you treat it
orchiectomy, chemo, RPLND
Treatment of stage 2 NSGCT
- orchiectomy
- RPLND
- chemo if >2cm
What is the best surveillance for NSGCT
AFP and HCG
Good risk seminoma
- any primary site
- no nonpulmonary visceral metastases
- normal AFR, HCG and LDH
Intermediate risk seminoma
- any primary site
- nonpulmonary visceral metastases
- normal AFR, HCG and LDH
Good risk NSGCT
- gonadal or retroperitoneal primary tumor
- no nonpulmonary visceral metastases
- good tumor markers
Intermediate risk NSGCT
- gonadal or pretroperitoneal primary tumor
- no nonpulmonary visceral metastases
- intermediate tumor markers
Poor risk NSGCT
-mediastinal primary tumor or
-nonpulmonary visceral mets
or
poor tumor markers
How do you treat recurrent testicular cancer?
if chemo naive–> BEP
if not–> VIP
If a patient relapses within 4 weeks of initial chemo what do you do
high dose chemo protocol
If your patient has a late relapse (after 2 years) what is the treatmetn
aggressive surgical approach w/ systemic chemo
Risk factros for prostate cancer
- AA race
- high dietary fat intake
- family Hx
What are most prostate cancers? Where do they arise
adenocarcinoma in the peripheral zone
How would a patient with prostate cancer present
most are asymptomatic
- LUTS
- hematuria/hematospermia
Where are the most common mets for prostate cancer
axial skeleton
When should men begin to get screening for prostate cancer? What should be done?
PSA and DRE starting at 40 years old
How is prostate cancer diagnosed
transrectal ultrasound guided bx
What tests are done to stage prostate cancer
- MRI
- bone scan
When should a bone scan be done in a patient with prostate cancer
PSA >10-20
What is used to help determine prognosis in prostate cancer
Gleason staging
2-10 score
Tx for prostate cancers
- active surveillance
- prostatectomy +/- pelvic LN dissection
- radiation
- hormone therapy
What makes prostate cancer low risk
T1-T2a, gleason <6, PSA 10-20
What makes prostate cancer intermediate risk
T2b, gleason 7, PSA 10-20
What makes prostate cancer high risk
T2c, gleason 8-10, PSA >20
Low risk localized prostate cancer tx
- active surveillance
- radiation
- prostatectomy +/- node dissection
Intermediate localized prostate cancer tx
- radiation (EBRT, brachytherapy or both
- prostatectomy w/ LN dissection
High risk localized prostate cancer tx
- ERBT + ADT (2-3 years)
- ERBT+ brachytherapy+ ADT (1 year)
- prostatectomy w/ LN dissection
T3b-T4 prostate cancer tx
- prostatectomy+ LN dissection
- EBRT+ADT
- ERBT+ brachytherpy+ADT
- ADT alone
Any T, N1, M0 prostate cancer tx
- prostatectomy+ LN dissection (+XRT)
- ADT
- XRT+ADT
What LNs are typicaly positive with prostate cancer
- obturator
- internal iliac
Tx of metastatic prostate cancer
-ADT
-GnRH agonist
-LHRH antagonist
-complete androgen blockade
-nonsteriodal anti androgens
-bisphosphonates
-surgery
-radiation
ALL PALLIATIVE
What does the Kattan nomogram assess
liklihood pt remains cancer free at 5 years post prostatectomy or CRT
What does the CAPRA nomogram assess
likelihood of PSA recurrence 3 and 5 years post prostatectomy
