Testicular Cancers Flashcards
GCT %
95%
95% arise in testes
Peak 25-35
10-20% present with distant mets
B/l gct %
2% m/c metachronous
Risk factors for testicular ca
White race Crypto 4-6 times . Pexy- 2-3 F/h/o P/h/o ITGCN( GCNIS)
F/h/o risk testes cancer
Brother- 8-12 times RR-
Father 2-4
12 times risk for c/l
GCNIS
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.
Gcnis predispose most testicular ca except
Spermatocytic seminoma
Teratoma
GCT chr abn
Isochromosome 12 p- 70-80%
Seminomas never produce AFP
15% - HCG
PLAP +
CD117+
Cd30 neg
Nsgct - 55%
Teratoma-47% mixed
Teratoma no hormones
Chemoresistant so surgery only
.
Most undiff nsgct
Embryonal ca AE PLAP OCT NEG FOR CKIT
High hcg
Chorioca- cytotrophoblasts Dx
Lung liver brain mets
Schiller duval- in 50% cases
Yolk sac tumor-AFP
Genetics test ca
Kit ligand pathway Kit P53 Kras Nras Braf 12i
Serum marker at what time is used for staging in testeca
3-4 wks after orchidectomy
Half life of AFP
5-7 days N - <16 ng Embryonal ca Yst Teratoca
T1/2 b hcg
24-36 hrs Chorioca Emryonal Teratoca 7%seminoma N<3mIU
LDH-1 testes
30-80 pure seminoma
60- nonseminomatuos
Ihc in testes
Seminoma-Plap, cd117/ckit, oct3/4
Embryo and yst- AE, Cam 5.2
Embryonal Carcinoma but not in Seminoma- CD
30
TESTIS SPARING SURGERY
Partial orchidectomy • Indications: - 2 to 3 cm tumour, - Polar - 30% testicular volume in solitary testis - Bilateral tumours.
Staging ptnm testes
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
Seminomam /c stage
Stage 1-
Active surveillance -10-15% micromets to rpln occult
Adjuvant rt or ct
Act for testes
Carboplatin
Stage 2 and 3 chemo except les than 3 cm - rt may be given
Bep
Nsgct occult in stage 1
20-30% micromets in rp
Stage 1 nsgct
Active surveillance
Primary rplnd
ACT
Post chemotherapy management of nsgct stage IA IB IlA 1IB
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
Salvage rplnd
After second line chemo rpln size increase but markers negative
Desperate rplnd
Markers and size increases
Postchemo rplnd
Matkers normal
Ln >1cm
Technique of rplnd
Split and roll technique
Stromal tumor testes
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
M/c sexcord tumor
Leydig cell -80 %
Reinkies crystals
M/c test ca after 50 yrs
Nhl
M/c paratesttumor
Adenomatoid tumor
