Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Skin Radiation therapy > Testicular cancer > Flashcards

Testicular cancer Flashcards

1
Q

testicular cancer is the most common cancer in ____

A

young men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ages for testicular cancer

A

non-seminoma- most common in men 17y.o.
seminoma- most common in men 30-34 yo
Rare after 40 y.o.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what countries is testicular cancer most common in

A

western countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what causes testicular cancer

A

Undescended Testicles (Cryptorchidism)
6X increased risk and 2X increased risk in contralateral testicle
Infertility: 20X increased risk
Family history/Genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which testis the longest

A

left testes is longer than the righ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the testes are contained in the ____ and are suspended by _____

A

contained in the scrotum

suspended by the spermatic cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
what structure transports the sperm from the testes?
A. Ejaculatory ducts
B.spermatic cords
C. Vas deferens
D. urethra
A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
the ejaculatory duct opens into the:
A.prostatic urethra
b. spermatic cord
c. penis
d. vas deferens
A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
what organ produces sperm?
A. testes
B.epididymis
C.seminal vesicles
D. prostate
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

primary LN drainage of the testes is?

a. paraaortics
b. inguinal
c. common iliac
d. arbitrator LN

A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q 
the tumour marker used to diagnose testicular cancer is ?
A. ca19-9
b.PSA
C. AFP
D.HER2/neu
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
\_\_\_\_\_ is a risk factor for testicular cancer
A. +age
B.hispanic ethnicity
C.cryptorchidism
D.Trauma to the testicles
A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
primary treatment of testicular cancer is ?
A.SX
B.CX
C.observation 
D.XRT
A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
Sup border when treating testicular cancer with EBRT is?
A.T8
B.T10
C.T12
D.L2
A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is not true about XRT of testicular cancer?
A.the orichetomy scar must be included in the TX field
B.late toxicity includes infertility
C.N&V are an acute side effect
D. lower dose/ fx is used to - acute toxicities

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

function of the testes

A

they house the spermatozoa at different stages of production and they produce testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

vas deferens

A

transports the sperm to the ejaculatory duct
A close network of anastomosing tubes in a fibrous stroma at the upper end of the testis the tubes converge together into the vas deferent enters the pelvis along the spermatic cord and empties into the seminal vesicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

whats the epididymis

A

which is a hard, cord-like structure about 2 feet in length and 5 mm in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ejaculatory ducts

A

one on each side, begin at the base of the prostate, run forward and downward between its middle and lateral lobes, and end in the verumontanum after entering the prostate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

tumour progression seminoma vs non-seminoma

A

Nonseminoma – Goes to lymph and blood
Seminoma – Goes to lymph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

cells of origin for testicular cancer

A

germ cell origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

sites of distant mets for testicular cancer

A

lung bone and brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

clinical presentation of testicular cancer

A

Mass or swelling in next (Lt supraclavicular nodes)
Gynecomastia (enlargement of the breasts, related to production of HCG)
Painless testicular mass (10-20%)
Heaviness (up to 40%)
Discomfort
Swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

presentation testicular cancer indicative of mets

A 
back pain (indicative of bone mets)
chest symptoms (indicative of lung mets )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what type of testicular cancer is most common?

A

seminoma is slightly more common than non seminoma

germ cell tumours is most common 95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

staging testicular cancer

A

T1: Tumor limited to testis and epididymis, no vascular/lymphatic invasion
T2: Tumor limited to testis and epididymis, with vascular/lymphatic invasion or involvement with the tunica vaginalis
T3: Tumor invades spermatic cord
T4: Tumor invades scrotum
N1: Mets to single node <2 cm or multiple nodes none more than 2 cm
N2: Mets to single node 2-5 cm or multiple nodes any >2 cm but none >5 cm
N3 Node greater than 5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how is testicular cancer detected and diagnosed

A

Testicular ultrasound

Radical Orchidectomy: Removal of testis and spermatic cord through the groin, avoids scrotal violation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

serum markers used in staging testicular cancer

A

Serum α-Fetoprotein (AFP) = Non seminoma component
Serum β-Human Chorionic Gonadatrophin (β-HCG) = present in choriocarcinoma, moderately ↑in seminoma
Serum Lactate Dehydrogenase (LDH) = ↑80% metastatic seminoma, 60% of advanced non seminoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

routes of spread for non-seminoma

A

Non-Seminoma
Can spread to the lymphatics or hematogenously
If they metastasize, it usually involves the lungs and liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

distant mets for non seminoma

A

lungs and liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

spread for seminoma

A

paraaortic retroperitoneal LN- to LN in the mediastinum and supraclavicular fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

distant mets for seminoma

A

involve the lung parenchyma, bone, liver, or brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

which has the worst prognosis seminoma or non seminoma

A

seminoma is better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

primary treatment testicular cancer

A

surgery is primary therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

surgical procedure used for testicular cancer treatent

A

radical orichetomy
A surgical procedure to remove a testicle and the full spermatic cord through an incision in the lower lateral abdomen (inguinal incision).

36
Q

is the testicle radio sensitive or radio resistant

A

radio sensitive

37
Q

use of radiation therapy in testicular cancer

A

its used adjuvantly after surgery in stage 1 and 2 cancer seminomas depending on size of ln

38
Q

DOSES AND ENERGY FOR TESTICULAR CANCER

A

Dose: 25/20 or 20/10
Energy: 6-18MV

39
Q

Nodes included in treatment volume of testicular cancer

A

Ipsilateral pelvic nodes (internal and external iliac nodes)
Para-aortic nodes
Ipsilateral renal hilar nodes

40
Q

indications for adjuvant XRT in testicular cancer

A

Radiation to the nodal regions at risk of having subclinical disease

41
Q

rationale chemotherapy

A

Used as an ADJUVANT treatment for both seminoma and non-seminoma

42
Q

chemo agents used for testicular cancer

A

Carboplatin
Has less side effects than cisplatin
Relapse rates are low
BEP (bleyomyacon, etopisode and platinum) – Cisplatin based regimen
Toxicity common in kidney, hearing, neurological, small vessels

43
Q

what chemo agents are used for seminoma vs non seminoma cancer

A

Seminomas – Carboplatin or BEP

Non-Seminomas - BEP

44
Q

Treatment of seminoma stage 1 vs non seminoma

A

seminoma
primary treatment is always radical orichetomy
Surveillance
Adjuvant Radiation 30/20, 25/15, 20/10 XRT of the para-aortic and ipsilateral pelvic LN
Adjuvant Chemo Carboplatin (rare and very unlikely
non seminoma
primary treatment is radical orichetomy
Surveillance
Adjuvant Chemo BEP x 2

45
Q

treatment of stage 2a-b seminoma vs non seminoma

A

seminoma:radical orichetomy +Depends on size of nodes
<5cm: Adjuvant Radiation 25/20 (Dog Leg) +/- 10/20 (concurrent) (Nodes) XRT of the paraaortic and ipsilateral pelvic LN
>5cm: Adjuvant Chemo BEP x 3 Not usual Chemo can be used but no need to have RT + chemo

nonseminoma:radical orichetomy +
Chemo BEP x 3
Additional Sx – Retroperitoneal node dissection (RPLND)
Difficult to resect due to nerves and vessels required for ejaculation

46
Q

treatment of stage 2c-4 seminoma vs non seminoma

A

seminoma- radical orichetomy +
Chemo BEP x 3-4
Don’t do radiation because worried about kidney toxicity depending on location of tumour stage 2c

nonseminoma: radical orichetomy +Chemo BEP x 3-4

47
Q

CT scan limits for testicular cancer

A

Sup Border : T7-8
Inf Border: 5cm inf of ischial tuberosities

48
Q

special immobilization for testicular cancer

A

requires testicular / scrotal shielding 1cm thick to reduce internal scatter to <1-2%

49
Q

what does NOT need to be included in the treatment volume

A

NOT surgical scar, scrotum or inguinal nodes because not a lot of recurrence there

50
Q

Dog leg/ hockey stick treatment typical technique

A

AP/PA is usually treated with extended SSD

51
Q

dog leg/ hockey stick treatment borders

A

Sup: Top of T10
Inf: Top of obturator foramen
Lat: to include para-aortic, pelvic and renal hilar nodes
Lateral border based on external iliacs + 2 cm margin
Medial border based on para-aortics + 2 cm margin

52
Q

what do we concentrate on treating lt vs rt dog leg technique

A

rt sided we concentrate on treating LN by the right testicular vein
lt sided we notch fields by the lt kidney the renal hilum nodes are at risk

53
Q

when is testicular shielding used/ not used

A

used in patients who are young and still want to father children, not used in older men or men who have a vasectomy

54
Q

what is the modified dog leg

A

we can use par aortic fields the ind border is moved up to the acetabulum, wheres the inf border in the dog leg is the arbitrator foramen

55
Q

paraaortic fields borders and what method is it treated with

A

AP/PA fields
Sup:top of T10
inf:L5
the width is 10-12 cm to include the paraaortic LN

56
Q

acute side effects of XRT to the testicle

A

nausea and diahrrea

57
Q

chronic side effects of XRT to the testicle

A

infertility and low sperm count

more toxicity comes from chemotherapy therefore chemo and radiation should NOT be given concurrently

58
Q

crossover of lymph channels left and right in the testis commonality

A

crossover from right to left is constant but crossover from left to right happens rarely and only occurs after the primary nodes are filled

59
Q

seminoma is most often diagnosed at what stage

A

stage 1 ( confined to the testes)

60
Q

seminoma drainage

A

spreads in an orderly fashion to retroperitoneal LN first, then to the lymphatics in the mediastinum and supraclavicular fossa

61
Q

most common presentation of testicular cancer

A

painless swelling in the scrotum

62
Q

occult testicular cancer is usually diagnosed by

A

US

63
Q

Staging systems used for testicular cancer

A

Royal Marsden Hospital system , UICC and AJCC

64
Q

SA, S2 and S3 levels

A

serum levels that can be used to diagnose testicular cancer
S1- LDH <1.5XN AND hCG <5000 and AFP<1000
S2-LDH 1.5-10, or hCG 5000-50,000 or AFP1000-10,000
S3-LDH >10 or hCG >50,000 OR AFP >10,000

65
Q

SURVEILANCE IN TESTICULAR CANCER

A

used in stage 1 seminoma (better prognosis) patient is followed for 10 years, most common site of relapse is retroperitoneum

66
Q

stage 2c seminoma treatment depending on location

A

Disease is confined to the retroperitoneum and is 5-10cm in diameter
if the mass is centrally located the patient will get XRT after SX
If the mass is is located so that the volume covers most of one kidney or liver cispltinum chemotherapy should be used

67
Q

what dose is spermatogenesis compromised at

A

the production of sperm

this is compromised at doses as little as .5Gy and 2 Gy can lead to permanent damage

68
Q

side effects of cisplatinum chemo

A

nausea vomiting and alopecia

69
Q

acute chemo side effects

A

myelosupression, pulmonary fibrosis, cisplatinum nephrotoxicity

70
Q

late chemo side effects

A

secondary cancer when chemo is given in germ cell tumours, high tone hearing loss, renal dysfunction, hypertension, raynauds phenomenon

71
Q

surgical side effects

A

most common is infertility, infection, pulmonary embolus and ascites

72
Q

is XRT more important in semnoma or non seminoma

A

seminoma

73
Q

weight of testes

A

15-19g

74
Q

how long are the seminiferous tubules

A

35-70 cm

75
Q

function of sertoli cells

A

nutritional, regulatory and supportive of the germ cells

76
Q

function of leydig cells

A

produces testosterone

77
Q

what dose causes - sperm count? azoospermia?

A
  • sperm count can occur between .15-.35 Gy and azoospermia occurs in almost all men after 1Gy
78
Q

after XRT can men produce sperm again? how long does it take for sperm production to resume?

A

sperm production occurs after 7 months if they receive 1Gy, or after 24 months with 6 Gy

79
Q

what single dose fraction causes complete sterilization

A

6.5-9 Gy however if this dose is fractionated the sperm production will usually recover eventually

80
Q

how long his it recommended that the patient try not to have kids after treatment

A

6 months after finishing all treatments

81
Q

what subtype of testicukar carcinoma is diagnosed with mets

A

choriocarcinoma (non seminoma)

82
Q

1st site f distant mets

A

lungs

83
Q

what could elevated serum markers indicate post-oricheyomy ?

A

could indicate metastatic cancer

84
Q

is prognosis better for seminoma or non seminoma

A

seminoma is better

85
Q

what is a normal sperm count

A

> 20 ,million

86
Q

what LN are treated in stage 1 and how what are the treatment field borders

A

AP/PA fields which include PA and retroperiineal LN

S: T11 i:L5 L: 10 cm wide to include transverse processes

87
Q

CT scan limits

A

t7-8 to 5 cm below ischial tuberosities

Skin Radiation therapy (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions