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17th European Urology Residents Education Programme > Testis cancer > Flashcards

Testis cancer Flashcards

1
Q

Nonguideline directed care of patients with testicular cancer is common, most frequently in the form om inappropriate imaging and overtreatment. What does it lead to?

A

Delayed definitive therapy
Unnecessary morbidity
Higher rates of relaps

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2
Q

How common is testicular cancer in western society?

A

3-10 cases per 100,000 males/year

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3
Q

Hur stor andel av urologisk cancer utgörs av testikelcancer?

A

5%

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4
Q

What is the most common type of testicular cancer and what are the two subgroups?

A

Germ cell tumours (90-95%)

Non-seminoma
Pure seminoma

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5
Q

Utredning för misstänkt testikeltumör?

A 
Kliniskt examination
-skrotum
- palpabel resistens i buken
-gynekomasti
-palp supraklavikulärt
Ultraljud
Tumörmarkörer
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6
Q

What are the Serum Tumour markers (STMs) for testicular cancer?

A

AFP: produced by yolk sac cells

hCG expression of trophoblasts

LDH (lactate dehydrogenase)

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7
Q

When is hCG elevated with testicular cancer?

A
  • all choriocarcinomas

- 50% embryonal carcinomas

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8
Q

What information can you gain from LDH (lactase dehydrogenase)-levels with testicular cancer?

A
  • less specific
  • proportional to tumour volume
  • elevated in 80% of advanced testicular cancer
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9
Q

What is the proper course of action with life threatening disseminated testicular cancer?

A

Lifesaving chemotherapy with delayed orchiectomy after completion of induction chemotherapy

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10
Q

When should you perform and orchiectomy after diagnosing testicular cancer?

A

Preferably within 24-48 hours and no later than 10 days

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11
Q

When should you consider performing organ-sparing surgery with testicular cancer?

A

Synchronous bilateral testicular tumours
Metachronous contralateral tumours
A tumour in a solitary testis with normal pre-operative testosterone levels

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12
Q

What are the riskfactors for contralateral testicular tumours?

A

testicular volume <12 mL

a history of cryptorchidism or poor spermatogenesis

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13
Q

When is a contralateral biopsy not necessary (when performing surgery for testicular cancer)?

A

In patients older than 40 years without risk factors

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14
Q

What information do you need for a complete staging and grading of testicular cancer?

A

Histopathology
Postoperative tumour markers
CT

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15
Q

What are the histopathological criteria for testicular cancer?

A
  • pT category
  • histological type
  • peri-tumoural venous and/or lymphatic invasion
  • presence of GCNIS
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16
Q

Mention a few Non-seminomal cancers of the testicle:

A 
Embryonal carcinoma
Yolk sac  tumour
Trophoblastic tumours
Teratoma, post-pubertal type
Teratoma with somatic-type malignancies
Mixed germ cell tumours
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17
Q

Mention two Benign tumours of the testicle:

A

Spermatocytic tumour

Teratoma, prepubertal type

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18
Q

Hur stor andel av testikelcancer utgörs av icke “Germ cell tumours”?

A

2-4% hos vuxna män

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19
Q

When should you perform a FDG PET CT with testicular cancer?

A

Only if you have a residual mass at least 6 week after chemotherapy when treating a seminoma

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20
Q

What are teh progsnostic risk factors for stage 1 testicular cancer?
(answer for both seminoma and non-seminoma)

A

Seminoma:
tumour size >4 cm
invasion of rete testis

Non-seminoma:
vascular invation in blood or lymphatic vessels
percentage of embryonal carcinoma >50%
proliferation rate >70%

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21
Q

What Germ Cell tumours doesn’t need any other therapy than orchiectomy?

A

Spermatocytic tumour

Prepubertal teratoma

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22
Q

What is the relapse risk with stage 1 seminoma?

A

15-20% in 5 years

23
Q

How do you treat a relapse of testicular seminoma?

A

Chemotherapy

24
Q

What is the overall cancer-specific survival rate of testicular seminomas?

A

97-100%

-even postponed therapy is efficient

25
Q

What is the main drawback with surveillance instead of chemotherapy with testicular seminomas?

A

The need for more intesive follow-up

26
Q

How should you treat stage 1 testicular seminoma?

A

Either:

Surveilance- at very low risk
-tumour size <4 cm without rete testis invasion

or

One-course carboplatin-based chemotherapy

27
Q

How should you NOT treat stage one testicular seminoma?

A

Radiotherapy

Retroperitoneal lymph node dissection (RPLD)

28
Q

Vad är uppföljningsprogrammet för stadium 1 testikel seminom?

A

DToch tumörmarkörer var 6:e månad i 2 år

DT och tumörmarkörer på slutet av år 3 och 5

29
Q

When does a relaps in stadium 1 NSGCT (non seminoma germ cell tumour) most often occur?

A

80% in the first year

30
Q

How often does stadium 1 NSGCT (non seminoma germ cell tumour) relapse?

A

30%

31
Q

Where does stadium 1 NSGCT (non seminoma germ cell tumour) most often relapse?

A

60% in the retroperitoneum

32
Q

How common is subclinical metastases in clinical stadium 1 NSGCT (non seminoma germ cell tumour)?

A

up to 30%

33
Q

What is the result of surveillance vs Adjuvant chemotherapy in stadium 1 NSGCT (non seminoma germ cell tumour)?

A

Surveillance –> 30% recurrence/relapse

Adjuvant chemotherapy –> <2% recurrence/relapse

34
Q

What is risk-adapted treatment in stadium 1 NSGCT (non seminoma germ cell tumours)?

A 
Low risk (stage 1A- pT1, no vascular invasion) --> surveillance
(if not willing one course of BEP)

High risk (stage 1B, pT2-4) –> one(two) courses of BEP

35
Q

What does BEP stand for in the treatment for testicular cancer?

A

Cisplatin
Etoposide
Bleomycine

36
Q

When should you perform a nerve-sparing retroperitoneal lymph node dissection on patients with stage 1 NSGC (non seminoma germ cell tumours)?

A

to highly selected aptients only:

those with contraindication to adjuvant chemotherapy and unwilling to accept surveillance

37
Q

When should you perform a Brain scan (CT/MRI) on a patient with metastatic testicular cancer?

A

I case of symptoms
and patients with metastatic disease with multiple lung metastases
and/or high beta-hCG values.

38
Q

Vilken utredning är obligat vid misstänkt metastaserad testikelcancer?

A 
UL testiklar
Tumörmarkörer
DT-thorax+buk
MRI kotpelare OM patienten har symptom
DT-hjärna/MR OM patienten har symptom eller multipla lungmetastaser och/eller högt beta-hCG
39
Q

Vad är skillnaden mellan stadium M1a och M1b vid metastaserad testikelcancer?

A

M1a: metastaser i regionala lymfkörtlar och/eller i lungorna
M1b: andra metastaser

40
Q

Vad innebär stadium 1 testikelcancer?

A

Sjukdom begränsad till testikeln

41
Q

Vad innebär stadium II testikelcancer?

A

Retroperitoneala lymfkörtelmetastaser
IIA <2 cm
IIB 2-5 cm eller fler än 5st
IIC >5 cm

42
Q

Vad innebär stadium III testikelcancer?

A

IIIA lymfkörtelmetastaser som inte är regionala
IIIB lungmetastaser
IIIC metastaser till andra organ

43
Q

Which patients with metastatic testicular cancer have a poor prognosis?

A

Not any patients with seminoma

Patients with non-seminoma and:
mediastinal primary
non-pulmoary visceral metastases
AFP >10,000 ng/mL or
hCG >50,000 IU/L (10,000 ng/mL9 or
LD > 10 x ULN
44
Q

What is the standard treatment for stage IIA/B seminoma

A

Radiotherapy

2:hands alternativ är BEPx3

45
Q

What is the standard treatment for stage IIA/B NSGCT (non seminoma germ cell tumour)?

A

Chemotherapy

and RPLND of residual disease

46
Q

What is the one exception to chemotherapy for stage IIA/B NSGCT (non seminoma germ cell tumour)?

A

Stage IIA NSGCT & pure teratoma without elevated markers
–> nerve sparing RPLND or surveillance

47
Q

What is the cure rate of non-seminoma stage IIA testicular cancer?

A

98%

48
Q

Which factors correlate with preserved fertility after chemotherapy for testicular cancer?

A

cisplatin-dose
FSH
age

49
Q

What can you expect when it comes to fertility after chemotherapy for testicular cancer?

A

Most men with normal pre-treatment sperm analysis will return to normal by 3 years after chemo

50
Q

When is the spermatogenesis at its lowest after chemotherapy for testicular cancer?

A

10-14 months after chemotherapy

51
Q

How common it late realapse (>2 years) in
seminoma?
non-seminoma?

A

seminoma 1,4%

non-seminoma 3,2%

52
Q

What are the differential diagnosises when a patient has a late relapse of testicular cancer?

A 
Metastases from a new contralateral primary
A new primary EGGCT
Metastases from a new non - GCT primary
Transformed teratoma
Growing teratoma
53
Q

How do you treat late relapse (>2 years) NSGCT?

A

Surgery
if incomplete result of surgery –>salvage chemotherapy

rapidly rising hCG –> induction salvage chemotherapy before surgery

17th European Urology Residents Education Programme (17 decks)

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