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Prostate cancer > Testis neoplasm > Flashcards

Testis neoplasm Flashcards

1
Q

What are the two major types of testis tumors

A
  1. Germ Cell

2. Sex cord/stromal tumors (Leydig/Sortoli)

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2
Q

Into which two categories are germ cell tumors divided?

A
  1. Seminoma

2. Non-seminoma germ cell tumors

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3
Q

Classic seminoma: characteristics?

A
  1. peak incidence 35-40 years of age
  2. 15% contain syncytiotrophoblasts (bHCG production)
  3. arises from ITGCN
  4. Most common germ cell tumor
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4
Q

Name 4 NSGCTs

A
  1. Embryonal Carcinoma
  2. Yolk Sac/Endodermal Sinus Tumor
  3. Choriocarcinoma
  4. Teratoma
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5
Q

Characteristics of embryonal carcinoma

A
  1. Poorly differentiated,
  2. able to differentiate into other NSGCTs
  3. peak incidence 25-35 years of age
  4. Aggressive tumor with high rates of metasatsis
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6
Q

Characteristics of yolk sac (endodermal sinus tumor)

A
  1. Pure tumors are rare
  2. MC germ cell tumor in children/infants
  3. Present in 40% of mixed GCTs
  4. Make AFP
  5. Never make bHCG
  6. Schiller-duvall bodies on pathology
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7
Q

Characteristics of Choriocarcinoma

A
  1. Rare
  2. Aggressive
  3. Peak incidence 20-30 yo
  4. early hematogenous spread (including brain)
  5. High bHCG common
  6. No AFP
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8
Q

Characteristics of Teratoma

A
  1. Contains endoderm, mesoderm or ectoderm
  2. No AFP or bHCG
  3. Rare in adults, more common in peds
  4. half of mixed GCT contain teratoma elements
  5. Chemoresistant
  6. morbidity related to local growth and malignant transformation
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9
Q

AFP is elevated in which NSGCT

A

Embryonal and yolk sac

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10
Q

What is normal AFP

A

< 20-25 ng/ml

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11
Q

What is the half life of AFP

A

5-7 days

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12
Q

What is the half life of bHCG

A

24-26 h

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13
Q

Which tumors make bHCG

A

seminoma, embryonal, choriocarcinoma

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14
Q

LDH-1 half life

A

24 h

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15
Q

Primary left testis tumor lymph drainage?

A

Para-aortic lymph nodes

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16
Q

Primary right testis tumor lymph drainage?

A

Infrarenal interaortocaval lymph nodes, followed by paracaval and para-aortic regions

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17
Q

What is the initial site of metastasis in 70-80% of testis cancer?

A

retroperitoneum

18
Q

What percentage of patients will be understaged on imaging with a LN cut off of 1 cm?

A

30% will harbor occult metastatic disease

19
Q

What is pTis?

A

intratubular germ cell neoplasia

20
Q

what is pT1

A

limited to testis and epi, may involve albuginea but not vaginalis NO LVI

21
Q

what is pT2

A

tumor limited to testis and epi, with LVI, or tumor involving TVaginalis

22
Q

whats pT3

A

tumor invades spermatic cord

23
Q

whats pT4

A

tumor invades scrotum

24
Q

Clinical N0

A

no regional nodes

25
Q

Clinical N1

A

mets within 1-5 LN, all less than 2 cm

26
Q

Clinical N2

A

Mets within a LN > 2 cm, < 5 cm, or more than 5 nodes involved, no that have extranodal extension

27
Q

Clinical N3

A

mets in one or more nodes > 5 cm

28
Q

M0

A

no distant mets

29
Q

M1a

A

non regional distant metastatis, or pumonary mets

30
Q

M1b

A

Distant met in a site other than non regional LN or lung

31
Q

S0

A

Tumor markers WNL

32
Q

S1

A

LDH < 1.5x normal, bHCG < 5000, AFP < 1000

33
Q

S2

A

LDH 1.5-10x normal, HCG 5000-50,000; AFP 1000-10,000

34
Q

S3

A

LDH > 10x normal
HCG > 5,0000
LDH > 10,000

35
Q

Non seminoma good prognosis, risk group

A
  1. Testicular/Retroperitoneal primary
  2. No non pulmonary visceral met
  3. < = S1
36
Q

Non seminoma intermediate prognosis, risk group

A
  1. Testicular/Retroperitoneal primary
  2. No non pulmonary visceral met
  3. S2
37
Q

Non seminoma poor prognosis, risk group

A
  1. Mediastinal primary
  2. Non pulmonary visceral met
  3. S3
38
Q

Seminoma good prognosis risk group

A
  1. Any primary

2. No non pulmonary visceral mets

39
Q

Seminoma intermediate prognosis risk group

A
  1. Any primary

2. Non pulmonary visceral mets

40
Q

What factors predict relapse in seminoma

A

rete testis involvement

tumors ≥ 4 cm

41
Q

What percent of stage I seminoma patients relapse with surveillance? When is relapse most common

A

13%

2-3 years

42
Q

For stage I seminoma men who cannot adhere to surveillance, what treatment options are there?

A
  1. Single does of carboplatinum

2. Radiotherapy 20 gy

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