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Clin Med III Exam II > Testicular and Prostate Malignancy > Flashcards

Testicular and Prostate Malignancy Flashcards

1
Q

What are most primary testicular tumors

A

germ cell tumors

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2
Q

What are the two categories germ cell tumors are broken into

A

nonseminomatous

seminomas

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3
Q

What are the other type of less common testicular tumors

A

sex cord stromal tumors

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4
Q

What types of caners are nonseminomatous

A
  • embryonic cell carcinoma
  • teratoma
  • mixed cell type
  • choriocarcinoma
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5
Q

What types of cancers are sex cord stromal tumors

A
  • leydig tumor
  • sertoli cell tumor
  • granulosa cell tumor
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6
Q

What is a risk factor for testicular cancer

A

cryptorchism

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7
Q

Which side is testicular cancer more common on

A

right

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8
Q

How do patients with testicular cancer present

A
  • painless nodule/enlargement of the testis

- heavy sensation or dull ache

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9
Q

Diagnostic for testicular cancer

A
  • scrotal US
  • CT
  • serum tumor marker testing
  • retroperitoneal LN dissection
  • radical inguinal orchiectomy
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10
Q

Seminoma on US

A

hypoechoic lesion without cystic area

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11
Q

Non seminomatous germ cell tumors on US

A

not homogenous w/ calcifications, cystic areas, indinstinct margins

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12
Q

What finding on US would make you think it wasnt a malignancy

A

cystic or fluid filled mass

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13
Q

What serum markers are done for testicular cancer

A

-alpha fetoprotein
-beta human chorionic gonadotropin
lactate dehydrogenase

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14
Q

Where does regional metastases occur first with testicular cancer

A

retroperitoneal lymph nodes

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15
Q

When is an orchiectomy and RPLND done

A
  • initial evaluation
  • definitive histologic evaluation
  • primary local tumor control
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16
Q

What is the gold standard for staging of the retroperitoneum

A

RPLND

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17
Q

What type of testicular cancer do you have to do a RPLND with? Why?

A

NSGCT becasue it has a high risk of nodal involvement

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18
Q

Diagnosis and initial tx of seminoma

A

radical orchiectomy

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19
Q

Do seminomas show elevated tumor markers

A

no

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20
Q

Stage 1 seminoma tx

A
  • orchiectomy typically curative
  • adjuvant chemo (carboplatin)
  • radiation if not candidate for chemo
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21
Q

Tx for stage 2a seminoma

A

-orchiectomy with adjuvent XRT

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22
Q

What makes a seminoma stage 2A? 2b? 2c?

A

2a- <2cm involved LN
2b- 2-5 cm LN
2c- >5cm LN

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23
Q

Tx for stage 2b seminoma

A

orchiectomy with adjuvant chemo

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24
Q

If there is a seminoma with an elevated B-HCG what would you add to the tx

A

adjuvant cisplatin chemo

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25
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
26
What does the tx of stage 1 NSGCT depend on
relapse risk factors
27
What are the relapse risk factors for NSGCT
- lymphatic vascular invasion of testicular mass - embryonal carcinoma - T3 or T4 primary tumor
28
If there are no risk factors how would you treat stage 1 NSGCT
surveillance after orchiectomy
29
If risk factors are present in stage 1 NSGCT how would you treat it
orchiectomy, chemo, RPLND
30
Treatment of stage 2 NSGCT
- orchiectomy - RPLND - chemo if >2cm
31
What is the best surveillance for NSGCT
AFP and HCG
32
Good risk seminoma
- any primary site - no nonpulmonary visceral metastases - normal AFR, HCG and LDH
33
Intermediate risk seminoma
- any primary site - nonpulmonary visceral metastases - normal AFR, HCG and LDH
34
Good risk NSGCT
- gonadal or retroperitoneal primary tumor - no nonpulmonary visceral metastases - good tumor markers
35
Intermediate risk NSGCT
- gonadal or pretroperitoneal primary tumor - no nonpulmonary visceral metastases - intermediate tumor markers
36
Poor risk NSGCT
-mediastinal primary tumor or -nonpulmonary visceral mets or poor tumor markers
37
How do you treat recurrent testicular cancer?
if chemo naive--> BEP if not--> VIP
38
If a patient relapses within 4 weeks of initial chemo what do you do
high dose chemo protocol
39
If your patient has a late relapse (after 2 years) what is the treatmetn
aggressive surgical approach w/ systemic chemo
40
Risk factros for prostate cancer
- AA race - high dietary fat intake - family Hx
41
What are most prostate cancers? Where do they arise
adenocarcinoma in the peripheral zone
42
How would a patient with prostate cancer present
most are asymptomatic - LUTS - hematuria/hematospermia
43
Where are the most common mets for prostate cancer
axial skeleton
44
When should men begin to get screening for prostate cancer? What should be done?
PSA and DRE starting at 40 years old
45
How is prostate cancer diagnosed
transrectal ultrasound guided bx
46
What tests are done to stage prostate cancer
- MRI | - bone scan
47
When should a bone scan be done in a patient with prostate cancer
PSA >10-20
48
What is used to help determine prognosis in prostate cancer
Gleason staging | 2-10 score
49
Tx for prostate cancers
- active surveillance - prostatectomy +/- pelvic LN dissection - radiation - hormone therapy
50
What makes prostate cancer low risk
T1-T2a, gleason <6, PSA 10-20
51
What makes prostate cancer intermediate risk
T2b, gleason 7, PSA 10-20
52
What makes prostate cancer high risk
T2c, gleason 8-10, PSA >20
53
Low risk localized prostate cancer tx
- active surveillance - radiation - prostatectomy +/- node dissection
54
Intermediate localized prostate cancer tx
- radiation (EBRT, brachytherapy or both | - prostatectomy w/ LN dissection
55
High risk localized prostate cancer tx
- ERBT + ADT (2-3 years) - ERBT+ brachytherapy+ ADT (1 year) - prostatectomy w/ LN dissection
56
T3b-T4 prostate cancer tx
- prostatectomy+ LN dissection - EBRT+ADT - ERBT+ brachytherpy+ADT - ADT alone
57
Any T, N1, M0 prostate cancer tx
- prostatectomy+ LN dissection (+XRT) - ADT - XRT+ADT
58
What LNs are typicaly positive with prostate cancer
- obturator | - internal iliac
59
Tx of metastatic prostate cancer
-ADT -GnRH agonist -LHRH antagonist -complete androgen blockade -nonsteriodal anti androgens -bisphosphonates -surgery -radiation ALL PALLIATIVE
60
What does the Kattan nomogram assess
liklihood pt remains cancer free at 5 years post prostatectomy or CRT
61
What does the CAPRA nomogram assess
likelihood of PSA recurrence 3 and 5 years post prostatectomy

Clin Med III Exam II (11 decks)

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