Testicular tumors

Question 1

What are the MC types of testicular tumors

Answer 1

Germ cell (seminoma) (non-seminoma: mixed, embryonal, yolk sac, choriocarcinoma, teratoma) 
Stromal (leydig, sertoli, granulosa cell)

Question 2

RF for testicular tumors include

Answer 2

Cryptorchidism (undescended testis)
FHx
personal Hx
HIV

Question 3

What were previously but NO longer considered RF for testicular cancer

Answer 3

Diethylstilbestrol exposure in utero
testicular atrophy
trauma

Question 4

What are Sx of testicular tumors

Answer 4

Painless mass or swelling in testicle
R>L
Back pain or abdominal mass

Question 5

What are the ways testicular tumors can metastasize

Answer 5

Bilateral testis
Lymph to retroperitoneal nodes
Distant to lung, liver, brain, bone, kidney, adrenal, GI, spleen

Question 6

What labs are useful in evaluating testicular tumors

Answer 6

H&P
US
Tumor markers (AFP, beta HCG, LDH) 
LFT, CBC, Creatinine 
CXR

Question 7

How do you treat lymphoma

Answer 7

Refer to oncology

Question 8

How do you treat testicular tumors

Answer 8

Radical inguinal orchiectomy- outpt, scrotal compression, ice pack, elevate, po analgesics
can do sperm banking and prosthesis

Question 9

How long after orchiectomy should you wait before retesting testing tumor markers

Answer 9

Five half lives! 
AFP: 5 weeks 
B-HCG: 1-2 weeks 
LDH: 3 weeks 
Also recheck CT chest/abd/pelvis s/p orchiectomy

Question 10

How do you stage testicular tumors

Answer 10

Tumor, Nodes, Mets (TNM) 
T: 4 stages 
N: 3 stages 
D: stages M0-M1b
S: serum tumor markers post orchiectomy

Question 11

Post orchiectomy, depending on compliance, what can your work up include

Answer 11

Surveillance
Chemo (carboplatin. bleomycin. etoposide. cisplatin)
Radiation
Retroperitoneal Lymph Node Dissection

Question 12

What does Tumor marker surveillance include post-orchiectomy

Answer 12

q3-4 mo. x 2 years
q 6-12 mo. x 2 years
annually for life
(also do H&P at these times)

Question 13

What does imaging surveillance post orchiectomy include

Answer 13

CT A/P q6 mo x 2 years
CT A/P q6-12 mo q 1 year
annually x 2 years
-CXR as indicated

Question 14

What are ADE of chemotherapy s/p orchiectomy

Answer 14

Myelosuppression, nausea, fatigue

+/- infertility

Question 15

What are ADE of radiation s/p orchiectomy

Answer 15

Acute: nausea (also vomiting, fatigue, myelosuppression)
Later: PUD, gastritis, high risk CV death and secondary cancer

Question 16

What is the 5 year survival of seminomas (germ cell)

Answer 16

Stage 1: 98%
II A/B: >95%
IIC or III intermediate: 72%

Question 17

What is the 5 year survival for non-seminoma (germ cell)

Answer 17

Relatively the same as above, little bit better