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Principles and Procedures > Testicular Cancer > Flashcards

Testicular Cancer Flashcards

1
Q

What percentage of male malignancies does Testicular Cancer account for?

A

Less than 1%

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2
Q

Testicular Cancer is a common malignancy for males of what age group?

A

20-34

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3
Q

There is a higher rate of Testicular Cancer among what demographic of men?

A

White

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4
Q

What is the relation between Testicular Cancer and Gonads?

A

It is believed that gonadal dysgenesis (developmental abnormalities of the testes) could be an origin

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5
Q

What is cryptorchidism and whats its relation to Testicular Cancer?

A

Undescended testes and is a known etiological risk factor

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6
Q

What two conditions are present in men that have a higher incidence of Testicular Cancer?

A

Gonadal Dysgenesis and Cryptorchidism

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7
Q

Patients with one testicular tumor are at increased risk for developing a contralateral malignancy. True or False?

A

True

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8
Q

What other genetic factor is a risk factor for Testicular Cancer?

A

Family History

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9
Q

What are the two types of Testicular Cancer?

A

Seminoma and Non-Seminoma

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10
Q

What is a significant prognostic factor of Seminomas?

A

Tumor Stage

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11
Q

What is the difference in the prognosis of a Stage 1 Seminoma v. Stage 4 Seminoma?

A

Stage 1 has the best prognosis while Stage 4 has the worst prognosis with metastasis likely

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12
Q

What is are the three prognostic factors of Non-Seminomas?

A

Tumor Stage, Tumor Markers and Volume of Mets

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13
Q

What is the pathology of most testicular cancers?

A

Germ Cells (>90%)

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14
Q

What does germ cells produce?

A

Sperm

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15
Q

What is the most common type of testicular cancer?

A

Seminoma

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16
Q

What are the three subtypes of Seminomas?

A

Classic, Anaplastic, Spermatocytic

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17
Q

What are the four subtypes of Non-Seminomas?

A

Embryonal Carcinoma, Yolk Sac, Choriocarcinoma, Teratoma

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18
Q

What is the most common subtype of testicular cancer in children?

A

Yolk Sac

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19
Q

What is the staging of testicular cancer base on?

A

Disease extent and tumor Markers

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20
Q

What staging system is used for Testicular Cancer?

A

TNM staging

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21
Q

What is contained inside the scrotum?

A

Testes

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22
Q

The scrotum is suspended by what structure?

A

Spermatic Cord

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23
Q

What is a common difference between the left and right spermatic cord?

A

The left usually longer than the right

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24
Q

What type of cells do testes house?

A

Spermatozoa

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25
Q

What hormone is produced by the testes?

A

Testerone

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26
Q

What structure is a continuation of the epididymis?

A

Vas Deferens

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27
Q

What structures do the Vas Deferens empty into?

A

Seminal Vesicles

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28
Q

As sperms exits the Seminal Vesicles, It enters the ____ and then proceeds into the ___?

A

Ejaculatory duct and Prostate

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29
Q

What lymphatics are involved in Testicular Cancer?

A

Periaortic nodes, Common/Internal/External Iliacs

30
Q

Crossover of lymphatic metastasis is common in what direction?

A

Right to left

31
Q

What does Testicular Cancer present as visually or physically?

A

Swelling or Nodular Mass

32
Q

What does Testicular Cancer present as in terms of symptoms? (3 answers)

A

Dull ache, pulling sensation, aching in lower abdomen

33
Q

What is present in 5% of patients with germ cell tumors?

A

Gynecomastia

34
Q

If testicular tumor is suspected, what test is completed?

A

Testicular Sonogram

35
Q

What is the procedure that includes an inguinal incision to diagnose and remove the primary tumor?

A

Radical Orchiectomy

36
Q

Why is a biopsy not appropriate for testicular cancer?

A

Due to the risk of seeding and manually spreading the cancer

37
Q

How does a blood test indicate a testicular tumor?

A

High Tumor Markers (Beta HCG and AFP (FOR NON-S))

38
Q

What are the two tests done for testicular cancer with semen?

A

Semen analysis and Sperm banking

39
Q

What is the primary route of spread for Testicular Cancer?

A

Lymphatics

40
Q

What nodes are commonly involved in the spread of testicular cancer?

A

Para-aortics, L-spine and Interior to Kidneys

41
Q

What nodes are involved on the left side of the body?

A

Para-aortic nodes below renal vein

42
Q

What nodes are involved on the right side of the body?

A

Nodes along the IVC

43
Q

What nodes are at risk for metastasis from the para-aortic spread through the thoracic duct?

A

Mediastinum or S’Clav nodes

44
Q

What is a common conception made on the spread of seminomas?

A

Localized or Lymphatic spread

45
Q

What is a common conception made on the spread of non-seminomas?

A

Hematogenously or Lymphatic spread to lung or liver

46
Q

What percentage of testicular caner patients present with Stage IV disease?

A

less than 5%

47
Q

What typically occurs after the staging of Testicular Cancer?

A

Radical Inguinal Orchiectomy

48
Q

Management after Radical Inguinal Orchiectomy is dependent on what factors?`

A

Staging and Disease extent

49
Q

Seminomas are not very radiosensitive. True or False?

A

False, they are very radiosensitive

50
Q

What is the typical dosage for seminomas?

A

2500 cGy

51
Q

What is the percentage of recurrence if only an orchiectomy is performed?

A

20%

52
Q

In the U.S what is the treatment of choice for a stage 1 disease?

A

Post-op XRT

53
Q

What is the difference between Stage 1 and Stage 2A treatment techniques?

A

The fields and doses are the same but the margins cover the enlarged nodes

54
Q

What is the difference between Stage 1 and Stage 2B treatment techniques?

A

Para-aortics and ipsilateral pelvic nodes irradiated with margins to cover enlarged nodes

55
Q

What is the name of the field type used to treat testicular cancer?

A

Dog Leg

56
Q

What are some shielding devices used in the treatment of testicular cancer? (3 answers)

A

Custom blocks/MLC to block 2/3 of lateral kidneys, Clamshell to avoid radiation to other testicle, AP-PA fields

57
Q

What is the dose for Stage 2B Testicular Cancer?

A

25-30 Gy

58
Q

What is special about the treatment technique for Stage 2C Testicular Cancer?

A

The technique is individualized. If mass is central and does not overlap (XRT primarily) but if mass to large or overlaps (Chemo)

59
Q

What is the initial treatment for nonseminomas?

A

radical inguinal orchiectomy then chemotherapy

60
Q

Why are residual masses usually removed?

A

40% are teratomas and 10-15% carcinomas

61
Q

Why are teratomas specifically removed?

A

Evidence shows that higher chances of relapse from teratomas and also better outcomes if mass is removed

62
Q

What is the dosage given for Stage 1 and Stage 2A non- seminomas?

A

2500 cGy

63
Q

What is the dose limit on the contralateral kidney that is being blocked?

A

1800 cGy

64
Q

What is the dose limit of a significant portion of the liver?

A

3000 cGy

65
Q

In Europe, what is changing for testicular cancer treatments?

A

Pelvic nodal radiation being eliminated

66
Q

What is the 5-year survival rate for Stage 1 Testicular Seminoma?

A

95-97%

67
Q

What is the 5-year survival rate for Stage 2A & 2B Testicular cancer?

A

90-95%

68
Q

The survival rates of Stage 2C, 2D, and 3 are dependent upon what factors?

A

Initial Size of tumor and therapeutic approach

69
Q

What are three side effects of testicular cancer XRT?

A

Nausea/Vomiting, Diarrhea and Severe Dyspepsia, peptic ulcers

70
Q

50% of patients present with ____ as a result of Testicular Cancer XRT?

A

Decreased sperm count

71
Q

Permanent sterility occurs at what dose?

A

200 cGy

Principles and Procedures (27 decks)

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