Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

FRCR CO2A > Testicular Cancer FRCR CO2A > Flashcards

Testicular Cancer FRCR CO2A Flashcards

1
Q

What are the RFs for Testicular Cancers ?

A
  1. Cryptoorchidism and infertility
  2. Pesticides
  3. 10 fold increased relative risk in a brother of an affected relative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What Syndromes are a/w Testicular Cancer

A

Klinfelter’s syndrome and Down Syndrome

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

Association of cryptorchidism and Testicular Cancer

A

10 fold increase

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

what are major types of Testicular Cancer

A

GCTs (Seminoma, Teratoma, Mixed tumor, spermatocytic seminoma)
NGCT (sex cord/stromal tumors, leydig cell tumors, sertoli cell tumors ) etc

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

is there any role of screening in Testicular Cancer

A

No, Testicular Cancer pts should be tought about self examination bcoz they run high risk of 2nd c/l cancers

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

whats the pattern of spread of Testicular Cancer

A

1st station Lns are the inter aortocaval nodes for right side tumors and left para aortic for lt sided tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classify GCTs

A
  1. ITGCN
  2. Teratoma or non seminoma
  3. seminoma, classical or spermatocytic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

whats are symptoms of advanced Testicular Cancer

A

fatigue, wt loss, back pain, dyspnoea due to lung mets or assoc PE, para aortic mass cause ureteric obstuction and HDUN and renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

whats the mc clinical presentation of Testicular Cancer

A

painless testicular swelling

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

Whats the presentation of mediastinal GCTs

A

Classic s/s of SVCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations are done for Testicular Cancer

A
  1. markers: Beta HCG, AFP, LDH
  2. Testicular USG
  3. CECT of chest Abdomen and Pelvis
  4. MRI brain if choriocarcinoma or pt is poor prognostic group, particularly very high Beta HCG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

whats the significance of Beta HCG in Testicular Cancer

A
  1. arises from syncytiotrophoblastic elements and raised in 10 - 20% of pts with seminoma and around 35% of those with teratoma
  2. massive increase may suggest metastatic choriocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Whats the significance of AFP in Testicular Cancer

A
  1. arise from yolk sac elements
  2. 60% of pts who have teratoma but not in Patients with Seminoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

whats the significance of LDH in Testicular Cancer

A

prognostic grouping

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

what are prognostic categories for Testicular Cancer

A
  1. IGCCCG 1997
  2. 3 groups, Good prognosis, metastatic, 95% cure, Intermediate prognosis, metastatic, 80% cure, Poor prognosis, metastatic 50% cure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

who are included in good pronostic group

A

all of the following
1. AFP < 1000 ng/ml
2. B HCG < 5000 ng/ml
3. LDH < 1.5 ULN
4. Testicular primary site

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

Who are included in intermediate prognostic group

A

Any of the following
1. AFP 1000 - 10000 ng/ml
2. B HCG 5000 - 50000 ng/ml
3. LDH 1.5 - 10 x ULN
4. primary site: retroperitoneal teratoma or any non testicular seminoma site

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

Who are included in poor prognostic group

A

Any of the following
1. AFP >10000 ng/ml
2. B HCG >50000 ng/ml
3. LDH >10 x ULN
4. primary site: mediastinal teratoma, liver brain, bone mets (non pulmonary visceral mets disease)

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

Which levels of markers are used for prognostic group allocation

A

post orchidectomy, not preoperative levels

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

How is ITGCN managed?

A
  1. found in 5% along GCTs in c/l testes, 50% progression to cancer within few years
  2. RT (20 Gy/ 10#), may cause infertility and disrupt LEydig cell function, may require lifelong Testosterone replacement or
  3. routine biopsy of c/l testicle the time of orchidectomy for GCT or
  4. Testicular Self Examination and annual USG follow up

pt must decide

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

How is Stage I seminoma treated

A

with adjuvant therapy, even when relapse risk is low, as it is very sensitive to both chemo and radio

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

How is Stage I teratoma treated

A

Surveillance, trend towards BEP in high risk pts, bcoz teratomas produce tumor markers more commonly than seminomas, surveillance is easier

23
Q

How is metastatic Testicular cancer treated

A

Combination Chemotherapy

24
Q

Why is stage I seminoma treated

A

15-20% relapse after orchidectomy, primarily within PA nodes

25
what are predictive factors for relapse of seminoma stage I
tumor size > 4 cm 25% Rete testes invasion LVSI but unreliable as it can appear as an artefact of slide preparation
26
what are treatment options for adjuvant treatment in stage I seminoma
Adjuvant RT to PA nodes Adjuvant Chemotherapy with single cycle of Carboplatin AUC 7
27
How is survellance done in Stage I seminoma post Treatment?
REgular CT scanning, every 3 - 6 months in 1st year then annual screening or MRI of PA region combined with CXR and tumor markers to decrease radiation doses
27
whats the pattern of relapse in stage i seminoma patients
1. treated with PA RT: Chest and pelvis 2. treated with Carboplatin: PA region gives a rationale for combining them in Rx of stage II seminoma
28
How is stage II seminoma treated ?
1. stage IIa/IIb: DOG leg RT with a boost for bulky disease, 20% failure rate, unacceptably high, those require ChT or 2. A single course of carboplain befor RT 3. PA strip RT and Carboplatin single cycle 4. Stage IIC : combination chemotherapy
29
how does location of tumor help in treatment decision making for stage II seminoma
Right Side: can be treated with RT and single cycle of Carboplatin Left Side: combination ChT as overlie the left kidney, which will get higher RT dose
30
Whats RT dose in adjuvant Seminoma treatmetn?
20 Gy/ 10# for stage I 30 Gy/ 15# for stage IIa/b
31
what is target volume for Stage I Seminoma
PA strip from around T11 to L5, lateral borders 4 to 4.5 cm from the midline, caution on left side
32
What is Dog Field RT
similar to PA field but extends inferiorly to include the I/L iliac nodes to the level of the obturator foramen
33
what are borders of Dog Field RT
lateral extends to the pelvic side walls, medially the bladder: central pelvic contents can be shielded
34
what are s/e of RT
1. nausea, can be managed with 5 HT3 antagonists 2. Infertility, Dog leg deliver 40 cGy of scattered radiation to the scrotum, chances of infertility
35
what advice should be given to patient before ChT or RT
Sperm banking and avoid conception for 6 to 12 months, possibility of teratogenic effect
36
HOw is stage I teratoma treated?
depends on LVSI status
37
How is Stage I teratoma without LVSI treated
1. Low risk of relapse, < 20%, managed by surveillance, relapse can be cured with ChT
38
How are pts of Stage I teratoma without LVSI followed up
1. tumor markers return to normal after surgery, monthly visits initially but after 6 to 12 months, intervals can be extended every 2 month 2nd year, 3 month in 3rd year, 4-6 months in year four, five and then annually
39
what tests should be done on follow up for Stage I teratoma without LVSI
1. Tumor markers and CxR 2. follow up CT done at around 3 months and at 1 year
40
How is Stage I teratoma with LVSI treated
1. high chances of relapse 45% 2. 3 ways of managment A. Surgical Staging (with 2 BEP for pN+ disease) B. Adjuvant Chemotherapy with 1 - 2 cycles of BEP: reduce the relapse to 2% C. Surveillance with 3 cycles of BEP who relapse
41
How are pts with borderline nodal enlargement on CT managed
PET scan is often misleading, not recommended early repeat CT approx 6 to 12 weeks combined with regular marker estimations: usually provides enough information
42
How is metastatic GCTs treated?
BEP regimen 3 to 4 cycles
43
whats the s/e of Bleomycin
Pneumonitis, gradually increasing SOB and dry cough
44
Can Bleomycin be removed from BEP
No, reduces cure rates
45
Can Carboplatin replace cisplatin
no inferior results
46
How can cisplatin induced renal toxicity be reduced
with adequate hydration and magnesium replacement
47
How is residual mass post ChT in teratoma managed?
1. Observation not advised 2. may undergo subsequent malignant change within mature teratoma 3. RPLND : if viable malignancy is found, further chemo should be considered
48
How is residual mass post ChT in seminoma managed?
1. RT to patients with a PET positive Residual mass 2. PET negative: observation
49
what are options in 2nd L
VIP (Etoposide, Ifosfamide, cisplatin) TIP (Paclitaxel, Ifosfamide, Cisplatin)
50
After how much time , follow up in Testicular GCTs be called off?
5 years except those with metastatic NSGCTs
51
What is spermatocytic seminoma
1. Benign and slow growing 2. older man, fewer than 5% of seminomas 3. No Ovarian Counterpart, not a/w usual RF for testicular cancer, not descended from germ cell carcinoma in situ 4. Metastatic disease virtually unknown
52
How are sex cord stromal tumors of Testes treated
Orchidectomy and staging CT, PA nodal disease found, surgery with node disssection

FRCR CO2A (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions