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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
Q

What needs to be done post-treatment of a seminoma

A
  • 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
Q

What does the tx of stage 1 NSGCT depend on

A

relapse risk factors

27
Q

What are the relapse risk factors for NSGCT

A
  • lymphatic vascular invasion of testicular mass
  • embryonal carcinoma
  • T3 or T4 primary tumor
28
Q

If there are no risk factors how would you treat stage 1 NSGCT

A

surveillance after orchiectomy

29
Q

If risk factors are present in stage 1 NSGCT how would you treat it

A

orchiectomy, chemo, RPLND

30
Q

Treatment of stage 2 NSGCT

A
  • orchiectomy
  • RPLND
  • chemo if >2cm
31
Q

What is the best surveillance for NSGCT

A

AFP and HCG

32
Q

Good risk seminoma

A
  • any primary site
  • no nonpulmonary visceral metastases
  • normal AFR, HCG and LDH
33
Q

Intermediate risk seminoma

A
  • any primary site
  • nonpulmonary visceral metastases
  • normal AFR, HCG and LDH
34
Q

Good risk NSGCT

A
  • gonadal or retroperitoneal primary tumor
  • no nonpulmonary visceral metastases
  • good tumor markers
35
Q

Intermediate risk NSGCT

A
  • gonadal or pretroperitoneal primary tumor
  • no nonpulmonary visceral metastases
  • intermediate tumor markers
36
Q

Poor risk NSGCT

A

-mediastinal primary tumor or
-nonpulmonary visceral mets
or
poor tumor markers

37
Q

How do you treat recurrent testicular cancer?

A

if chemo naive–> BEP

if not–> VIP

38
Q

If a patient relapses within 4 weeks of initial chemo what do you do

A

high dose chemo protocol

39
Q

If your patient has a late relapse (after 2 years) what is the treatmetn

A

aggressive surgical approach w/ systemic chemo

40
Q

Risk factros for prostate cancer

A
  • AA race
  • high dietary fat intake
  • family Hx
41
Q

What are most prostate cancers? Where do they arise

A

adenocarcinoma in the peripheral zone

42
Q

How would a patient with prostate cancer present

A

most are asymptomatic

  • LUTS
  • hematuria/hematospermia
43
Q

Where are the most common mets for prostate cancer

A

axial skeleton

44
Q

When should men begin to get screening for prostate cancer? What should be done?

A

PSA and DRE starting at 40 years old

45
Q

How is prostate cancer diagnosed

A

transrectal ultrasound guided bx

46
Q

What tests are done to stage prostate cancer

A
  • MRI

- bone scan

47
Q

When should a bone scan be done in a patient with prostate cancer

A

PSA >10-20

48
Q

What is used to help determine prognosis in prostate cancer

A

Gleason staging

2-10 score

49
Q

Tx for prostate cancers

A
  • active surveillance
  • prostatectomy +/- pelvic LN dissection
  • radiation
  • hormone therapy
50
Q

What makes prostate cancer low risk

A

T1-T2a, gleason <6, PSA 10-20

51
Q

What makes prostate cancer intermediate risk

A

T2b, gleason 7, PSA 10-20

52
Q

What makes prostate cancer high risk

A

T2c, gleason 8-10, PSA >20

53
Q

Low risk localized prostate cancer tx

A
  • active surveillance
  • radiation
  • prostatectomy +/- node dissection
54
Q

Intermediate localized prostate cancer tx

A
  • radiation (EBRT, brachytherapy or both

- prostatectomy w/ LN dissection

55
Q

High risk localized prostate cancer tx

A
  • ERBT + ADT (2-3 years)
  • ERBT+ brachytherapy+ ADT (1 year)
  • prostatectomy w/ LN dissection
56
Q

T3b-T4 prostate cancer tx

A
  • prostatectomy+ LN dissection
  • EBRT+ADT
  • ERBT+ brachytherpy+ADT
  • ADT alone
57
Q

Any T, N1, M0 prostate cancer tx

A
  • prostatectomy+ LN dissection (+XRT)
  • ADT
  • XRT+ADT
58
Q

What LNs are typicaly positive with prostate cancer

A
  • obturator

- internal iliac

59
Q

Tx of metastatic prostate cancer

A

-ADT
-GnRH agonist
-LHRH antagonist
-complete androgen blockade
-nonsteriodal anti androgens
-bisphosphonates
-surgery
-radiation
ALL PALLIATIVE

60
Q

What does the Kattan nomogram assess

A

liklihood pt remains cancer free at 5 years post prostatectomy or CRT

61
Q

What does the CAPRA nomogram assess

A

likelihood of PSA recurrence 3 and 5 years post prostatectomy

Clin Med III Exam II (11 decks)

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