Testicular Cancer Flashcards
What are the age groups associated with testicular cancer?
- Seminoma (25-40)
- Teratoma (20-35)
- NHL (50+)
What are the risk factors for testicular cancer? (11)
- testicular maldecsent
- early age puberty/ sexual activity
- decreased sperm count/ low fertility
- testical trauma
- vasectomy
- smoking whilst in the womb
- pre-natal oestrogen exposure
- mumps orchitis
- genetic i.e. short arm iso-chromosome
- ethnicity (caucasian)
- sedentary lifestyle
What are the signs and symptoms of testicular cancer?
Primary: - infertility - pain in testical - palpable mass Secondary: - gynecomastia - abdominal pain - loin pain - haemoptysis from lung mets - loss of appetite/ weight loss.
What are the different histologies of testicular cancer?
- Mostly germ cells (95%); most are seminomas, then teratomas and finally some are a combination.
- If not germ cell then mostly NHL - Leidig /stertoli or rhabdomyosarcomas.
What are the different staging systems used for testicular cancer?
- Numerous systems in place
- TNM (similar to that of lymphomas)
- Royal Marsden
- IGCCC prognostic grouping.
What is the lymphatic spread for testicular cancer?
- spreads locally to the epididymis and spermatic cord.
- lymphatic spread goes first to the level of the renal hilum par aortic nodes, then would spread either superior to the mediastinal and supra-clavicular nodes or inferior to lower par aortic nodes and eventually the pelvic nodes. Potentially invading the scrotum and inguinal nodes.
- Distant spread and go to the lungs, or to the pineal / suprasellar regions.
What different surgeries are used in the management of testicular cancer?
- Orchiectomy: remove the spermatic cord as high as possible, done through inguinal incision, definitive for all tumours.
- Teratoma - in the usa do extended retroperitoneal lymphadectomy.
- Late stage/ non-germ cell: nodal desemination.
How would you manage Germ Cell Ca (stage 1-11B) and Germ Cell Ca (over stage 11B)
How would you manage non-germ cell cancer?
Germ cell stage 1 - 11B: Surgery ( inguinal orchiectomy most likely) +- PORT to the para-aortic nodes +- ipsilateral nodes.
Germ cell beyond stage 11B - Surgery + Post op chemo
Not a germ cell: surgery (nodal destination) + post op chemo.
DONT USE RT EXCEPT FOR METS.
What is the gold standard of chemo for Germ Cell tumours?
What is the gold standard of chemo for non-germ cell tumours?
Germ Cell:
- used beyond stage 11B
- Use BEP = bleomycin, eptopside and cisplatin 3 cycles
Non-germ cell: (used all time)
- CHOP (x6 cycles) = doxorubicin, cyclophosphamide, vincristine & predisone
What are the acute side effects of testicular cancer?
Acute:
- pulmonary fibrosis
- gut disturbance
- nephrotoxicity
What are the late side effects of testicular cancer?
- hearing loss (tinnitus)
- infertility
- peripheral neuropathy
- arterial hypertension
What is the purpose of surveillance for testicular cancer?
- Avoids over treatment
- 80% patients are treated with surgery alone, 20% relapse but 99% of these pts are treated successfully with salvage chemotherapy.
What is volumed in EBRT of testicular cancer?
- para-aortic nodes +- ipsilateral lns.
What is the dose fractionation for testicular cancer?
20-30Gy in 10-15#
What are some of the tx considerations for testicular ca?
- use testicular shielding
- ant/ post pair
- dog leg to achieve dose to pelvic nodes
- shield kidneys
