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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

Seminoma 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 workup and treatment

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 workup and treatment

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 further treatment

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 further treatment

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 further workup and treatment

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 further treatment

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
# Testis pT2 Staging | 1
pT2 -> Tumor limited to testis with LVI, invading hilar soft tissue, epididymis or tunica albuginea
26
# Testis pT3 | 1
pT3 -> Invading spermatic cord
27
# Testis pT4
pT4 -> Invades scrotum
28
# Testis cN Staging | 3
cN1 -> RP LNs less than 2cm cN2 -> RP LNs between 2-5cm cN3 -> RP LNs greater than 5cm
29
# Testis pN Staging | 3
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
# Testis M staging | 2
M1a -> Non RP LNs or pulmonary metastasis M1b -> Visceral metastasis
31
# Testis S Staging | 3
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
# Testis Stage I | 3
Stage Ia -> pT1 N0 M0 S0 Stage Ib -> pT2-4 N0 M0 S0 Stage Is -> pT1-4 N0 M0 S1-3
33
# Testis Stage II | 3
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
# Testis Stage III | 3
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
# Testis Risk Categories | 5
* 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
# TCa Stage I Seminoma s/p AS: Follow up | 3
* 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
# TCa Stage I Seminoma s/p treatment: Follow up | 3
* H&P: q6 x2y, annual x3 * A/P Img: annual x2, as indicated * CXR: as indicated | super mild
38
# TCa Stage II Seminoma s/p RPLND: Follow up
* 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
39
# TCa Stage IIA and NB IIB Seminoma s/p RT or chemo: Follow up | 3
* H&P: q3 x1y, q6 x4y * A/P Img: q6 x1y, annual x2y, as indicated * CXR: q6 x2y, annual x1, as indicated | hot
40
# TCa Stage IIA Seminoma s/p RPLND w/chemo: Follow up | 3
* H&P: q3 x1y, q6 x4y * A/P Img: q6 x1y, annual x2y, as indicated * CXR: q6 x2y, annual x1, as indicated | hot
41
# TCa Stage IIB, IIC and III Seminoma: Follow up | 3
* 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
# TCa Stage I NSGCT w/o RF s/p AS: Follow up | 3
* 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
# TCa Stage I NSGCT w/RF s/p AS: Follow up | 3
* 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
44
# TCa Stage I NSGCT s/p RPLND or chemo: Follow up | 3
* H&P: q3 x1y, q6 x4y * A/P Img: q6 x1y, annual x2y, as indicated * CXR: q6 x2y, annual x1, as indicated | hot
45
# TCa Stage II-III NSGCT s/p chemo (CR): Follow up | 3
* 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
46
# TCa Stage II NSGCT s/p primary RPLND and adjuvant chemo: Follow up | 3
* H&P: q6 x2y, annual x3 * A/P Img: annual x2, as indicated * CXR: q6 x1y, annual x2, as indicated | mild
47
# TCa Stage II NSGCT s/p primary RPLND w/o adjuvant chemo: Follow up | 3
* 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
48
# TCa RT long-term toxicity | 2
* CVD HR 3.7 * 2nd malignancy HR 3.7
49
# TCa Chemo long-term toxicity | 3
* CVD RR 2.6 * Metabolic syndrome RR 2.2 * 2nd malginancy RR 1.8
50
# TCa TSS indications | 4
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
# TCa TSS principles | 3
* Inguinal approach * Frozen section with possible reflex radical orchiectomy * Biopsy of adjacent parenchyma
52
# TCa TSS counceling | 4
* High risk of local recurrence * Risk of testis atrophy, infertility or hypogonadism * Role of adjuvant radiation * Need for continued surveillance
53
STM False elevations
AFP: liver damage bHCG: hypogonadism and Marijuana use
54
Cryptorchidism and age risk
* 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

SUO (24 decks)

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