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Solid Tumor Oncology > Testicular Cancer > Flashcards

Testicular Cancer Flashcards

1
Q

Biggest risk factor for testicular cancer

A

Cryptorchidism

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2
Q

Genetic aberration commonly seen in testicular GCTs?

A

Isochromosome 12p

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3
Q

For mixed GCT, at what percentage of nonseminomatous pathology has to be present for the tumor to be classified as a nonseminoma?

A

1%.
Any amount of nonseminoma means it’s classified as nonseminoma

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4
Q

What STM is not produced by seminoma?

A

AFP

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5
Q

Half life of AFP

A

7 days

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6
Q

Half life of bHCG

A

3 days

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7
Q

Extremely high levels of bHCG, what cancer is that suggestive of?

A

Choriocarcinoma

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8
Q

Who should get brain MRI?

A

Predominance of choriocarcinoma
Extensive lung mets
Mets to organs other than lungs
Super high hCG or AFP

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9
Q

STM staging S1

A

AFP <1000
bHCG <5000
LDH <1.5x ULN

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10
Q

STM staging S2

A

AFP 1000 - 10,000
BHCG 5,000 - 50,000
LDH 1.5 - 10x ULN

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11
Q

STM staging S3

A

AFP >10,000
BHCG >50,000
LDH >10x ULN

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12
Q

What are risk factors for recurrence

A

Embryonal
LVI

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13
Q

What is special about the treatment of stage IS?

A

Treated like Stage III
Tany N0 M0 S1-3
Elevated STM after surgery means there’s likely disseminated disease

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14
Q

Mets to what location have a better prognosis?

A

Lungs

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15
Q

What makes disseminated seminoma intermediate risk?

A

Mets to site other than lungs
***STMs do not play a role

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16
Q

What makes disseminated seminoma poor risk?

A

Doesn’t exist

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17
Q

What are features of good risk nonseminoma? (2)

A

Mets to nodes and/or lungs
S0-1

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18
Q

What are features of intermediate risk nonseminoma? (2)

A

Mets to nodes and/or lungs
S2

19
Q

What are features of poor risk nonseminoma? (3)

A

Primary site in mediastinum
Mets to organ other than lungs
S3

20
Q

3 treatment options for Stage I seminoma?

A

Surveillance (relapse 17%) - preferred
2 cycles carboplatin (relapse 2%)
RT to RP (relapse 4%)

21
Q

What is a predictive value of relapse for stage I seminoma? (2)

A

Larger tumor
LVI

22
Q

Treatment options of stage I nonseminoma (3)

A

Surveillance (relapse rate 26%) - preferred
RPLND (11%)
BEP x1 (2%)

23
Q

What makes up stage I testicular cancer?

A

T1-4, N0, M0
Limited to testis, spermatic cord, scrotum

24
Q

What makes up stage II testicular cancer?

A

RP Nodal disease
Any T, N1-3, M0
STMs S1-2

25
Q

What staging criteria can change the treatment of stage II patients?

A

Node size.
Nodes >3 cm get chemo like stage IIIA
<3 cm can get chemo or RT or RPLND

26
Q

Treatment for Stage IIA or IIB seminoma (4)

A

RT
BEP x3
EPx4
RPLND - only for nodes <2 cm

27
Q

What is the distinguishing features of stage IIA/IIB?

A

LNs <3 cm

28
Q

What is the preferred treatment for stage IIB/IIC seminoma? (2)

A

BEPx3
EPx4

29
Q

Treatment for Stage IIA nonseminoma with S0? (3)

A

RPLND
BEP x3
EP x4

30
Q

Patient with stage II NSGCT who undergoes BEPx3 and has residual mass after chemo. What now?

A

RPLND

31
Q

Treatment for Stage II nonseminoma with S1 (2)

A

BEP x3
EP x4

32
Q

Patient with Stage IIA with S0 nonseminomatous GCT. Undergoes RPLND and has found to have 2 LNs positive for malignancy. Anything else to do to lower relapse risk?

A

2C of EP
can do 2C of BEP but not preferred

33
Q

Treatment for Stage III good risk seminoma? (2)

A

BEP x3
EP x4

34
Q

Three characteristics to make you consider EPx4 instead of BEP x4

A

Over age 50
poor renal function
COPD

35
Q

Treatment for Stage III good risk nonseminoma? (2)

A

BEP x3
EP x4

36
Q

Treatment for Stage III intermediate risk seminoma?

A

BEP x4
VIP x4

37
Q

Treatment for Stage III poor risk nonseminoma?

A

BEP x4
VIP x4

38
Q

2L chemo for relapsed disseminated disease (3)

A

VeIP
TIP
Carbo + Etop

39
Q

Which patients are at highest risk for VTE. What to do about it?

A

large RPLNs
Prophy DOACs

40
Q

in addition to pneumonitis, what other lung changes can bleomycin cause?

A

Pseudonodules. Inflammatory, not progression

41
Q

Patient with Stage III NSGCT undergoing BEP. STMs are responding but tumor is enlarging. What is going on and what do you do?

A

Growing teratoma syndrome.
Surgery

42
Q

Patient with intermediate risk Stage III NSGCT with lung mets undergoes 4C BEP and STMs have normalized, and imaging shows resolution of lung mets, but persistent PRLNs. He undergoes RPLND with 2 cm LNs with residual nonseminoma. What to do?

A

2 cycles of chemotherapy
(TIP, VeIP, VIP, EP)

43
Q

Treatment of primary mediastinum seminoma with no disease elsewhere? (2)

A

EP x4
BEP x3

44
Q

Patient with good risk Stage IIIS Seminoma undergoes BEPx3. His previously seen lung mets resolve but has persistent RPLNs on imaging. STMs have normalized. What to do? (2)

A

Surveillance
PET/CT. If positive, then resect or biopsy. If resected, then can give 2C of additional chemo if biopsy positive.

Solid Tumor Oncology (20 decks)

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