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Oncology boards > Testicular cancer > Flashcards

Testicular cancer Flashcards

1
Q

Testicular cancer RF

A

1) crypto-orchidism (undescended testes at birth)
*Both testes at risk, including descended testes
2) Agent orange
3) infertility
*Not smoking or obesity

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2
Q

Half life of beta-HCG and AFP

A

HCG half life one day
AFP 5 days

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3
Q

Management of primary mediastinal NSGCT

A
  • VIP x 4 cycles (Preferred - Bleo not used Require surgery and post-op complications higher with BEP)
    OR BEP x 4 cycles
  • Consult thoracic surgery for resection of residual mediastinal disease
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4
Q

Primary mediastinal seminoma management

A

BEP
Follow residual mass with surveillance CT chest

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5
Q

cytogenetic finding associated with testicular cancer

A

isochromosome 12p

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6
Q

Testicular mass tissue sampling

A
  • inguinal orchiectomy
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7
Q

Lymphatic spread of testicular cancer

A
  • to ipsilateral RP nodes, never to inguinal or pelvic unless anatomy has been altered (cryptoorchidism, bad urologist doing testicular biopsy)
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8
Q

1) general management of primary mediastinal NSGCT 2) preferred systemic therapy

A
  • VIP (not bleomycin)
  • thoracic surgery then resects residual mediastinal disease
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9
Q

management of primary mediastinal seminoma

A
  • good risk disease
  • BEP, then you follow residual mass w/ CT chest
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10
Q

clinical significance of path showing seminoma with AFP elevation

A
  • non seminoma component, by definition
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11
Q

other cause of beta-HCG elevation

A

marijuana

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12
Q

What to think with very high beta-HCG

A

choriocarcinoma

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13
Q

Seminoma risk categories

A
  • only 2: good or intermediate
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14
Q

Pulmonary mets in seminoma are classified as

A

good risk

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15
Q

Management of bleo toxicity in terms of continuing treatment

A

IF poor or intermediate risk, switch to ifosfamide
IF good risk, drop bleo and don’t substitute

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16
Q

1) Stage 1 seminoma mgmt options 2) Preferred option

A
  • surveillance (preferred)
  • consider XRT or 1-2 cycles carboplatin
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17
Q

Stage 2 seminoma mgmt

A

BEP x 3 cycles
EP x 4 cycles
(CONFIRM)

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18
Q

Stage 3 seminoma mgmt

A

BEP x 4 cycles
VIP x 4 cycles
(CONFIRM)

19
Q

What defines Good risk seminoma?

A

All of the following:
Any primary site
No metastases to organs other than the lungs and/or lymph nodes
Normal serum AFP
***Just remember that intermediate is presence of nonpulmonary visceral mets

20
Q

Intermediate risk seminoma

A

All of the following:
Any primary site
Metastases to organs other than the lungs and/or lymph nodes
Normal serum AFP

21
Q

What defines Good risk NSGCT?

A

All of the following:
Testicular or retroperitoneal primary tumors
No metastases to organs other than the lungs and/or lymph nodes
Serum AFP <1000 ng/mL, beta-hCG <5000 milli-international units/mL, and LDH <3 times the upper limit of normal*

22
Q

Intermediate risk NSGCT

A

All of the following:
Testicular or retroperitoneal primary tumors
No metastases to organs other than the lungs and/or lymph nodes
Serum AFP 1000 to 10,000 ng/mL* or
Serum beta-hCG 5000 to 50,000 milli-international units/mL* or
LDH 3 to 10 times the upper limit of normal*

23
Q

What defines poor risk NSGCT?

A

Any of the following:
Mediastinal primary with or without metastases
Metastases to organs other than the lungs and/or lymph nodes
Serum AFP >10,000 ng/mL*
Serum beta-hCG >50,000 milli-international units/mL*
LDH more than 10 times the upper limit of normal*

24
Q

Size cutoff for residual mass in seminoma

A

3 cm

25
Q

Management of residual mass in seminoma

A

IF residual mass <3cm → active surveillance
IF residual mass >3cm → PET
IF PET negative → active surveillance
IF PET positive → surgery

26
Q

Stage II seminoma mgmt

A

Stage IIA
RT (preferred -Including para-aortic and ipsilateral iliac lymph nodes to a dose of 30 Gy)
chemotherapy (EP for 4 cycles vs. BEP x 3 cycles)
Stage IIB
Given elevated beta-HCG, BEP x 3 cycles vs. EP x 4 cycles (Preferred)

27
Q

Germ cell subtype in which PET/CT has utility

A

Only in seminoma

28
Q

NSGCT and radiosensitivity

A

NSGCT is radioresistant so radiation not typically offered

29
Q

Stage IIB and IIC NSGCT mgmt

A

BEP x 3 cycles (Preferred) vs. EP x 4 cycles
IF residual mass >1cm, RPLND

30
Q

Stage IIA NSGCT mgmt

A

RPLND
IF deferring RPLND, BEP 3 cycles

31
Q

Advanced NSGCT mgmt

A
  • Good risk - BEP 3 cycles
  • Intermediate and poor risk disease
    BEP 4 cycles
32
Q

Size cutoff for residual mass in NSGCT + management

A

1) 1 cm
2) IF residual mass >1cm, immediate RPLND
IF residual mass <1cm, consider RPLND vs. surveillance

33
Q

Management of growing teratoma syndrome

A

immediate surgery

34
Q

Second line options for advanced NSGCT

A

Conventional-dose chemotherapy (CDCT) w/
TIP for 4 cycles (Preferred - Superior outcomes, but studied in a more favorable/chemo sensitive population)
VeIP for 4 cycles (Studied in a more broad group) (vinblastine, ifosfamide, cisplatin *different than VIP)
High-dose chemo (HDCT) w/ sequential (2-3) auto-HSCT (Much more toxic, unclear whether HDCT superior to CDCT

35
Q

long term toxicities of treatment for testicular cancer

A
  • secondary malignancies
  • neuropathy
  • Raynaud’s syndrome
36
Q

Good risk metastatic seminoma management

A

BEP for 3 cycles

37
Q

Seminoma radiographic findings on US

A

hypoechoic + well defined

38
Q

seminoma tumor markers

A
  • can have elevated beta-hCG
  • NO AFP elevation by definition
39
Q

Long term survival rate of seminoma

A

> 90%

40
Q

5 yr survival of good risk seminoma

A

91%

41
Q

5 yr survival of intermediate risk seminoma

A

79%

42
Q

5 yr survival of poor risk NSGCT

A

48%

43
Q

What is stage II disease in testicular cancer

A

Node positive

44
Q

What is stage III disease in testicular cancer

A

M1 disease

Oncology boards (41 decks)

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