Testis

Question 1

Testis lymphaetic drainage

Answer 1

Lymph node (LN) drainage. … Left testicle: testicular vein → left renal vein → paraaortic LN.
… Right testicle: testicular vein → IVC below level of renal vein → paracaval and aortocaval nodes.
… Prior inguinal surgery may disrupt drainage and redirect through iliac nodes.

Question 2

Testicular carcinoma type

Answer 2

A. Germ cell tumors:
1. seminoma: 45% -classical, spermatocytic, may be anaplastic
2. NSGCT(non -seminomatous germ cell tumor)55%
——
Embryonal cell carcinoma
Polyembryoma
Yolk sac tumor
Choriocarcinoma
Teratoma
B. Sex cord stromal tumors (3-4%)
- well differentiated gonadal stromal neoplasm
-gonadoblastoma, thecoma
-mixed forms
-undifferentiated
C. Others
-para testicular rhabdomyosarcoma
-non hodgkins lymphoma
-adenocarcinoma of rete testis
-mesothelioma (tunical vaginalis)

Question 3

Good prognostic factors in nsgct

Answer 3

Good prognosis All must be met: Testis or retroperitoneal primary
No non-lung visceral mets
 AFP < 1,000,
 hCG < 5,000, 
LDH <1.5× 
normal 5 yr PFS: 89%

Question 4

Poor prognostic factor in nsgct

Answer 4

Poor prognosis
Mediastinal primary or non-lung visceral mets or any of the following:
 AFP > 10,000 or 
hCG > 50,000 or
 LDH >10× 
normal 5 yr PFS: 41%

Question 5

RT dose for seminoma

Answer 5

Dose: For seminoma

Stage I: 20 Gy 10 # 2 weeks.

Stage II A: 30 Gy in 15 # in 3 wks.

Stage II B: 36 Gy in 18 # in 3 2 wks (for residual disease after CT)*

Scrotal irradiation with electron therapy using a lead cut-out-30 Gy in 15 # in 3

Question 6

1st line chemo for seminoma

Answer 6

Chemotherapy: Regimens are-1 line

BEP:

Bleomycin 30 unit IV bolus D1,8,15 Etoposide 100 mg/m² IV D1-5

Cisplatin 20 mg/m² over 30 min infusion D1-5. Repeated every 21 days. 3 (good risk patients) OR 4 (intermediate /poor risk) cycles. For good risk patients particularly with seminoma required CT 4 cycles of etoposide & cisplatin
EP: (dose-same as BEP)
without Bleomycin

Question 7

2nd line chemotherapy for testicular cancer

Answer 7

TIP( pacli, ifos, cpl)
VeIP: vinblastine, ifosfamide, CPL
High dose chemotherapy regimen
- carboplatin, etoposide
- paclitaxel, ifosfamide, carboplatin, etoposide

Question 8

Causes of secondary metastasis in testis

Answer 8

Small cell lung cancer
Melanoma
Leukemia
Prostate
Kidney

Question 9

Site of extragonadal germ cell tumor 10%

Answer 9

CNS: cranium, pineal gland, meninges, suprasellar region(pituitary)
Thyroid
Mediastinum : mostly anterior mediastinum
Retroperitoneum
Sacrum, paranasal sinus, soft tissue of head and neck

Question 10

Which of the tumor has no stage IV

Answer 10

Testicular carcinoma
Germ cell tumor
Thyroid carcinoma

Question 11

D/d of testicular mass

Answer 11

Epididymitis
Orchitis, hydrocele, vericocele,
Lymphoma, leukemia
Metastasis: from melanoma, lung

Question 12

BEP schedule details

Answer 12

2 different types found:
BEP weekly basis
Bleomycin 30mg IV bolus D1,8,15
Etoposide 100 mg/m2/d D1-5 or 120mg/m2 D1-5
Cisplatin 20mg/m2/d D1-5 or 40mg/m2 D1-5
(Remember 20,30,100 formula)
BEP 3 weekly basis
Bleomycin 15mg/day D1-3
Etoposide 120mg/m2 D1-3
Cisplatin 40mg/m2 D1-3

Question 13

Intermediate prognostic factor for NSGCT

Answer 13

Testis/retroperitoneal/ non mediastinal primary
And
No non pulmonary visceral mets and
AFP: 1000-10000 ng/ml
HCG: 5000-50000 u/L
LDH: 1.5 to 10 X upper limit of normal
It occurs in 28% of melanoma