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Uro Onc > Testis > Flashcards

Testis Flashcards

1
Q

TCa

Suspicious Mass Work-up

8

A
  • H&P
  • Labs including STMs
  • Scrotal US
  • Radical inguinal orchiectomy
  • Discuss sperm banking
  • Discuss testis prostesis
  • Consider CT C/A/P
  • Consider contralateral biopsy if abnormal
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2
Q

TCa

Seminoma Stage Ia and Ib Treatment

3

A
  • Surveillance [pT1-pT3] (p)
  • Single agent carboplatin
  • Radiation therapy
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3
Q

TCa

Seminoma Stage Is

2

A
  • Repeat elevated STMs
  • Repeat imaging
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4
Q

TCa

Seminoma Stage IIa

3

A
  • RT (including para-aortic and ipsilateral iliac nodes; 30Gy)
  • BEP x3 or EP x4
  • NS-RPLND
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5
Q

TCa

Stage IIb

1

A
  • BEP x3 or EP x4
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6
Q

TCa

Seminoma Stage IIc or Stage III

2

A

Good Risk
* BEP x3 or EP x4
Intermediate Risk
* BEP x4 or VIP x4 (Etoposide/ Ifosfamide/ Cisplatin)

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7
Q

TCa

Seminoma s/p Chemotherapy

6

A

Repeat Img and STMs

Mass 3cm or less and normal STM
* Surveillance

Mass greater than 3cm and normal STM
* Surveillance
* FDG-PET/CT negative: surveillance
* FDG-PET/CT equivocal: repeat in 6-8 weeks
* FDG-PET/ CT positive: RPLND or biopsy

Growing mass or positive STM
* VeIP x4 or TIP x4

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8
Q

TCa

Seminoma Second-line Chemotherapy

3

A
  • VeIP x4 (vinblastine/ ifosfamide/ cisplatin)
  • TIP x4 (Paclitaxel/ Ifosfamide/ cisplatin)
  • High-dose chemotherapy
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9
Q

TCa

Seminoma Post-Chemotherapy RPLND Adjuvant Treatment

3

A
  • Complete resection positive for seminoma: consider 2 cycles of chemotherapy (EP or TIP or VIP or VeIP)
  • Complete resection negative for seminoma: Surveillance
  • Incomplete resection or progression: VeIP x4 (Vinblastine/ Ifosfamide/ Cisplatin) or TIP x4 (Paclitaxel/ Ifosfamide/ Cisplatin)
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10
Q

TCa

Seminoma Third-line Chemotherapy

7

A

Prior first and second-line conventional dose
* High dose chemotherapy
* Third-line chemotherapy
* Microsatellite instability/ mismatch repair testing or tumor mutational burden testing
* RT (select pts)

Prior high dose chemotherapy
* Third-line conventional dose chemotherapy
* Microsatellite instability/ mismatch repair testing or tumor mutational burden testing
* RT (select pts)

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11
Q

TCa

NSGCT Pre-treatment Workup

3

A
  • CT C/A/P or MRI
  • Repeat STMs
  • Brain MRI with and without contrast if choriocarcinoma, extensive lung mets, viceral mets, neurologic symptoms, S3 AFP or S2 bHCG
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12
Q

TCa

NSGCT Risk Factors

3

A
  • Lymphovascular invasion
  • Predominance of embryonal carcinoma
  • pT3 or pT4
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13
Q

TCa

NSGCT Stage I without RFs Treatment

3

A
  • Surveillance (p)
  • NS-RPLND
  • BEP x1
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14
Q

TCa

NSGCT Stage I with RFs Treatment

3

A
  • Surveillance
  • BEP x1
  • NS-RPLND
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15
Q

TCa

NSGCT Stage Is Treatment

1

A
  • BEP x3 or EP x4
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16
Q

TCa

NSGCT Stage IIa Treatment

3

A

S0
* NS- RPLND
* BEP x3 or EP x4

S1
* BEP x3 or EP x4

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17
Q

TCa

NSGCT Stage IIb Treatment

3

A

S0, normal LN distribution
* BEP x3 or EP x4
* NS-RPLND (select pts)

S1 or abnormal LN distribution
* BEP x3 or EP x4

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18
Q

TCa

NSGCT Stage IIc and IIIa Treatment

2

A
  • Good Risk BEP x3 or EP x4
  • Int or Poor Risk BEP x4
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19
Q

TCa

NSGCT Stage IIa or IIb s/p chemotherapy

3

A

Negative markers, Residual mass <1cm
* Surveillance (p)
* NS-RPLND (select pts)

Negative markers, Residual mass >1cm
* NS-RPLND

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20
Q

TCa

NSGCT Treatment s/p post-chemo RPLND

2

A
  • Viable tumor in path: adjuvant chemotherapy x2 (EP or TIP or VIP or VeIP)
  • Teratoma or necrosis: surveillance (no need to resect extra-RP masses if fibrosis in the post-chemo RPLND specimen (12% chance of discordance)
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21
Q

TCa

NSGCT s/p primary RPLND

4

A
  • pN0: surveillance
  • pN1: surveillance (p) or EP x2
  • pN2: EP x2 (p) or surveillance
  • pN3: BEP x3 or EP x4
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22
Q

TCa

NSGCT s/p primary chemotherapy

5

A
  • Complete response, negative STMs: Surveillance (p) or NS-RPLND (select pts)
  • Partial response, negative STMs: RPLND
  • Partial response, rising STMs: second-line chemotherapy (or third-line)
  • Partial response, stable STMs: close surveillance
  • Partial response, normalizing STMs: consider RPLND
23
Q

TCa

NSGCT recurrence s/p chemotherapy

6

A

Early (<2y) relapse
* VeIP x4 or TIP x4
* High dose chemotherapy
* Consider surgical resection if solitary lesion

Late (>2y) relapse
* RPLND (p)
* VeIP x4 or TIP x4
* High dose chemotherapy

24
Q

Testis

pTis pT1 Staging

4

A

pTis -> Germ cell neoplasia in situ
pT1 -> Limited to testis without LVI
pT1a -> Seminoma less than 3cm
pT1b -> Seminoma greater than 3cm

25
Q

Testis

pT2 Staging

1

A

pT2 -> Tumor limited to testis with LVI, invading hilar soft tissue, epididymis or tunica albuginea

26
Q

Testis

pT3

1

A

pT3 -> Invading spermatic cord

27
Q

Testis

pT4

A

pT4 -> Invades scrotum

28
Q

Testis

cN Staging

3

A

cN1 -> RP LNs less than 2cm
cN2 -> RP LNs between 2-5cm
cN3 -> RP LNs greater than 5cm

29
Q

Testis

pN Staging

3

A

pN1 -> RP LNs less than 2cm and less than 5 positive nodes
pN2 -> RP LNs between 2-5cm or more than 5 positive nodes or ENE
pN3 -> RP LNs greater than 5cm

30
Q

Testis

M staging

2

A

M1a -> Non RP LNs or pulmonary metastasis
M1b -> Visceral metastasis

31
Q

Testis

S Staging

3

A

S1 -> AFP less than 1,000; BCG less than 5,000; LDH less than 1.5xN
S2 -> AFP 1,000-10,000; BCG 5,000-50,000; LDH 1.5xN to 10xN
S3 -> AFP greater than 10,000; BCG greater than 50,000; LDH greater than 10xN

32
Q

Testis

Stage I

3

A

Stage Ia -> pT1 N0 M0 S0
Stage Ib -> pT2-4 N0 M0 S0
Stage Is -> pT1-4 N0 M0 S1-3

33
Q

Testis

Stage II

3

A

Stage IIa -> T1-4, N1, M0, S0-1
Stage IIb -> T1-4, N2, M0, S0-1
Stage IIc -> T1-4, N3, M0, S0-1

34
Q

Testis

Stage III

3

A

Stage IIIa -> T1-4, N0-3, M1a, S0-1
Stage IIIb -> T1-4, N0-3, M1a, S2
Stage IIIc -> T1-4, N0-3, M1a-M1b, S0-3

35
Q

Testis

Risk Categories

5

A
  • Seminoma Good Risk -> no nonpulmonary mets
  • Seminoma Intermediate Risk -> visceral mets
  • NSGCT Good Risk -> Stage IIIa or less with testis or RP primary tumor
  • NSGCT Intermediate Risk -> Stage IIIb with testis or RP primary
  • NSGCT Poor Risk -Stage IIIc or Mediastinal primary
36
Q

TCa

Stage I Seminoma s/p AS: Follow up

3

A
  • H&P: q4 x1y, q6 x3y, annual
  • A/P Img: q4 x1y, q6 x1y, q6-12 x1y, annual x2
  • CXR: q4 x1y, q6 x1y, annual, as indicated

medium

37
Q

TCa

Stage I Seminoma s/p treatment: Follow up

3

A
  • H&P: q6 x2y, annual x3
  • A/P Img: annual x2, as indicated
  • CXR: as indicated

super mild

38
Q

TCa

Stage IIA and NB IIB Seminoma s/p RT or chemo: Follow up

3

A
  • H&P: q3 x1y, q6 x4y
  • A/P Img: q6 x1y, annual x2y, as indicated
  • CXR: q6 x2y, annual x1, as indicated

hot

39
Q

TCa

Stage IIA Seminoma s/p RPLND w/chemo: Follow up

3

A
  • H&P: q3 x1y, q6 x4y
  • A/P Img: q6 x1y, annual x2y, as indicated
  • CXR: q6 x2y, annual x1, as indicated

hot

40
Q

TCa

Stage IIB, IIC and III Seminoma: Follow up

3

A
  • H&P: q2 x1y, q3 x1y, q4-6 x1y, q6 x1y, annual
  • A/P Img: q4 x1, q6 x1, annual x3y
  • CXR: q2-4 x1y, q4-6 x1y, annual x3y

muy caliente

41
Q

TCa

Stage I NSGCT w/o RF s/p AS: Follow up

3

A
  • H&P: q2 x1y, q3 x1y, q4-6 x1y, q6 x1y, annual
  • A/P Img: q4 x1, q6 x1, annual x3y
  • CXR: q2-4 x1y, q4-6 x1y, annual x3y

muy caliente

42
Q

TCa

Stage I NSGCT w/RF s/p AS: Follow up

3

A
  • H&P: q2 x1y, q3 x1y, q4-6 x1y, q6 x1y, annual
  • A/P Img: q4 x1, q6 x1, annual x3y
  • CXR: q2-4 x1y, q4-6 x1y, annual x3y

muy caliente

43
Q

TCa

Stage I NSGCT s/p RPLND or chemo: Follow up

3

A
  • H&P: q3 x1y, q6 x4y
  • A/P Img: q6 x1y, annual x2y, as indicated
  • CXR: q6 x2y, annual x1, as indicated

hot

44
Q

TCa

Stage II-III NSGCT s/p chemo (CR): Follow up

3

A
  • H&P: q2 x1y, q3 x1y, q4-6 x1y, q6 x1y, annual
  • A/P Img: q4 x1, q6 x1, annual x3y
  • CXR: q2-4 x1y, q4-6 x1y, annual x3y

muy caliente

45
Q

TCa

Stage II NSGCT s/p primary RPLND and adjuvant chemo: Follow up

3

A
  • H&P: q6 x2y, annual x3
  • A/P Img: annual x2, as indicated
  • CXR: q6 x1y, annual x2, as indicated

mild

46
Q

TCa

Stage II NSGCT s/p primary RPLND w/o adjuvant chemo: Follow up

3

A
  • H&P: q2 x1y, q3 x1y, q4-6 x1y, q6 x1y, annual
  • A/P Img: q4 x1, q6 x1, annual x3y
  • CXR: q2-4 x1y, q4-6 x1y, annual x3y

muy caliente

47
Q

TCa

Stage IIA Seminoma s/p RPLND: Follow up

3

A
  • H&P: q4 x1y, q6 x3y, annual
  • A/P Img: q4 x1y, q6 x1y, q6-12 x1y, annual x2
  • CXR: q4 x1y, q6 x1y, annual, as indicated

medium

48
Q

TCa

RT long-term toxicity

2

A
  • CVD HR 3.7
  • 2nd malignancy HR 3.7
49
Q

TCa

Chemo long-term toxicity

3

A
  • CVD RR 2.6
  • Metabolic syndrome RR 2.2
  • 2nd malginancy RR 1.8
50
Q

TCa

TSS indications

4

A

Major function is hormonal preservation
* Synchronous bilateral tumors
* Solitary testis
* Radiographically benign in appearance
* Non-palpable tumor less than 2cm (<1cm is 50% benign)

51
Q

TCa

TSS principles

3

A
  • Inguinal approach
  • Frozen section with possible reflex radical orchiectomy
  • Biopsy of adjacent parenchyma
52
Q

TCa

TSS counceling

4

A
  • High risk of local recurrence
  • Risk of testis atrophy, infertility or hypogonadism
  • Role of adjuvant radiation
  • Need for continued surveillance
53
Q

STM False elevations

A

AFP: liver damage
bHCG: hypogonadism and Marijuana use

54
Q

Cryptorchidism and age risk

A
  • Risk of developing testis cancer in UDT after age 30 is very low
  • Risk of dying from TCa is lower than Risk of dying from surgery after age 32-50
  • At age 60, serial US are not needed

Uro Onc (23 decks)

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