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Crash > Testicular Cancers > Flashcards

Testicular Cancers Flashcards

1
Q

GCT %

A

95%
95% arise in testes
Peak 25-35
10-20% present with distant mets

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2
Q

B/l gct %

A

2% m/c metachronous

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3
Q

Risk factors for testicular ca

A 
White race
Crypto 4-6 times . Pexy- 2-3 
F/h/o
P/h/o
ITGCN( GCNIS)
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4
Q

F/h/o risk testes cancer

A

Brother- 8-12 times RR-
Father 2-4
12 times risk for c/l

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5
Q

GCNIS

A

GCNIS
Present in 80-90% of GCT
50 % risk of transformation in 5 years and 70% in
7 years
Microlithiasis in USG increases the risk.
GCNIS begins in utero.
• Field effect within the testicle.
5% and 9% of patients with GCT have GCNIS
within the unaffected contralateral testis.

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6
Q

Gcnis predispose most testicular ca except

A

Spermatocytic seminoma

Teratoma

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7
Q

GCT chr abn

A

Isochromosome 12 p- 70-80%

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8
Q

Seminomas never produce AFP

A

15% - HCG
PLAP +
CD117+
Cd30 neg

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9
Q

Nsgct - 55%

A

Teratoma-47% mixed

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10
Q

Teratoma no hormones

Chemoresistant so surgery only

A

.

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11
Q

Most undiff nsgct

A 
Embryonal ca
AE
PLAP
OCT
NEG FOR CKIT
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12
Q

High hcg

A

Chorioca- cytotrophoblasts Dx

Lung liver brain mets

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13
Q

Schiller duval- in 50% cases

A

Yolk sac tumor-AFP

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14
Q

Genetics test ca

A 
Kit ligand pathway
Kit
P53
Kras
Nras
Braf
12i
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15
Q

Serum marker at what time is used for staging in testeca

A

3-4 wks after orchidectomy

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16
Q

Half life of AFP

A 
5-7 days
N - <16 ng 
Embryonal ca
Yst
Teratoca
17
Q

T1/2 b hcg

A 
24-36 hrs
Chorioca
Emryonal
Teratoca
7%seminoma
N<3mIU
18
Q

LDH-1 testes

A

30-80 pure seminoma

60- nonseminomatuos

19
Q

Ihc in testes

A

Seminoma-Plap, cd117/ckit, oct3/4
Embryo and yst- AE, Cam 5.2
Embryonal Carcinoma but not in Seminoma- CD
30

20
Q

TESTIS SPARING SURGERY

A 
Partial orchidectomy
•
Indications:
- 2 to 3 cm tumour,
- Polar
- 30% testicular volume in solitary testis
- Bilateral tumours.
21
Q

Staging ptnm testes

A

pT1
Tumor limited to testis (including rete testis invasion) without lymphovascular invasion
pTia*
Tumor smaller than 3 cm in size
pT1b*
Tumor 3 cm or larger in size
pT2
Tumor limited to testis (including rete testis invasion) with lymphovascular invasion
Tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer
covering the external surface of tunica albuginea with or without lymphovascular invasion
pT3
Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion
pT4
Tumor invades scrotum with or without lymphovascular invasion
“Subclassification of piT1 applies to only pure seminoma.
(N
Regional Lymph Nodes
Regional lymph nodes cannot be assessed
No regional lymph node metastasis
Metastasis with a lymph node mass 2 cm or smaller in greates
dimension
OR
Multiple lymph nodes, none larger than 2 cm in greatest
dimension
Metastasis with a lymph nots mass larger than 2 cm but not
larger than 5 cm in greatest dimension
OR
Multiple lymph nodes, any one mass larger than 2 cm but not
larger than 5 cm in greatest dimension
Metastasis with a lymph node mass larger than 5 cm in
greatest dimension
Stage 1- confined testes
2- node
3- mets

22
Q

Seminomam /c stage

A

Stage 1-
Active surveillance -10-15% micromets to rpln occult
Adjuvant rt or ct

23
Q

Act for testes

A

Carboplatin

24
Q

Stage 2 and 3 chemo except les than 3 cm - rt may be given

A

Bep

25
Q

Nsgct occult in stage 1

A

20-30% micromets in rp

26
Q

Stage 1 nsgct

A

Active surveillance
Primary rplnd
ACT

27
Q 
Post
chemotherapy
management
of nsgct
stage IA IB IlA 1IB
A

Negative markers and residual mass more than
1 cm on CT: do RPLND
Negative markers and residual mass < 1 cm on
CT scan- keep on follow up

28
Q

Salvage rplnd

A

After second line chemo rpln size increase but markers negative

29
Q

Desperate rplnd

A

Markers and size increases

30
Q

Postchemo rplnd

A

Matkers normal

Ln >1cm

31
Q

Technique of rplnd

A

Split and roll technique

32
Q

Stromal tumor testes

A

5% to10% of all testicular tumors
90% - Benign tumours and 10% -malignant.
Suspect testicular stromal tumor
• Testicular mass with normal serum markers
• Associated with virilization&gynacomastia
• Unusual age at presentation (<10 or >55years)
• Bilateral mass with weight loss
•Slow growth of testicular tumor

33
Q

M/c sexcord tumor

A

Leydig cell -80 %

Reinkies crystals

34
Q

M/c test ca after 50 yrs

A

Nhl

35
Q

M/c paratesttumor

A

Adenomatoid tumor

Crash (20 decks)

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