Testicular Tumors Flashcards
What are testicular tumor types?
- Germ Cell (90-95%)
- Stromal
Germ cell tumors are separated into what 2 categories?
- Seminoma
- Non seminoma
Stromal tumors are separated into what 3 categories?
- Leydig
- Sertoli
- Granulosa
What are RFs for testicular tumors?
- Cryptorchidism
- Family hx
- Personal hx
- HIV
How do testicular tumors present?
- Painless mass or swelling in testicle
- R > L
- Back pain or abd mass
What are characteristics of metastatic testicular tumors?
- Bilateral
- Lymphatic: retroperitoneal lymph nodes
- Distant: lung, liver, brain, bone, kidney, adrenal, spleen
What are the 3 tumor markers used?
- Alpha-fetoprotein (AFP)
- Beta-HCG
- Lactate dehydrogenase (LDH)
What imaging studies are used to dx testicular tumors?
- U/S
- CXR (metastasis?)
What labs are used to dx testicular tumors?
- LFTs
- CBC
- Creatinine
Which type of tumors require referral to oncology?
Lymphomas
How do you tx testicular tumors?
Radical orchiectomy (scrotal or inguinal)
Describe: radical orchiectomy
- outpatient
- scrotal compression
- ice pack, elevation, analgesics
How long should you wait to check tumor markers post orchiectomy?
Five 1/2 lives
- AFP: 5 wks
- B-HCG: 1-2 wks
- LDH: 3 wks
What imaging should be performed post orchiectomy?
CT chest/abd/pelvis
How do you stage testicular tumors?
TNM system
- Tumor: Tx-T4
- Lymph nodes: Nx-N3
- Distant met: M0-M1b
S: serum tumor markers post orchiectomy
What are the 5 stages of testicular tumors?
- Stage I
- Stage IIA
- Stage IIB
- Stage IIC
- Stage III
What are the tx options post-orchiectomy?
- Surveillance
- Chemo
- Radiation
- Retroperitoneal Lymph Node Dissection (RPLND)
Describe: surveillance post-orchiectomy
- H&P, tumor markers q 3-4mos x 2 yrs
- H&P, tumor markers q 6-12 mos x 2 yrs then annually
What is the imaging schedule for surveillance post-orchiectomy?
- CT abd/pelvis q 6mos x 2 yrs
- CT abd/pelvis q 6-12mos x 1 yr, then annually
What are side-effects of chemo?
- Myelosuppression
- Nausea
- Fatigue
- Poss infertility
What are the acute side effects of radiation?
- Nausea
- Less frequent: vomiting, fatigue, myelosuppression
What are the long-term side effects of radiation?
- PUD, gastritis
- Increased CV risk
- Increased risk of 2ndary CA
