Therapeutics of Testicular Cancer (Weddle) Flashcards
What race is more likely to develop prostate cancer?
those murderous whites
What is the precursor lesion for invasive germ cell tumors of testicular cancer?
carcinoma in situ (CIS)
More than 95% of testicular cancers are _____________ tumors.
germ cell
What are the two histologic types of germ cell tumors?
seminoma and non-seminoma
What hormone do seminomas secrete?
β-hCG only
What hormones do non-seminomas secrete?
β-hCG and α-fetoprotein (αFP)
Which type of germ cell tumor is most common in the 4th decade of life?
seminoma
Which type of germ cell tumor has 4 major histopathologic subtypes?
non-seminoma
How should we treat a tumor that has both seminomatous and non-seminomatous elements?
treat as if it is non-seminomatous (the more aggressive one)
What is the only known predisposing factor for testicular cancer?
cryptorchidism
What is the most common symptom of testicular cancer (not advanced)?
painless mass in the testis
How may advanced testicular cancer present?
- Abdominal pain
- Back pain
- Change in bladder/bowel habits
- Nausea/vomiting
- Altered mental status
Where can left-sided testicular tumors spread to?
left para-aortic, pre-aortic, and inter-aortocaval lymph nodes
Where can right-sided testicular tumors spread to?
right pre-aortic, pre-caval, and inter-aortocaval lymph nodes
True or false: most testicular cancer patients will present with stage II disease
hell nah; 70% stage I
Why should you NEVER do a needle biopsy in the scrotum?
can contaminate the retroperitoneal lymph nodes resulting in metastatic disease
What tumor markers can help classify whether a patient is good-, intermediate-, or poor-risk for testicular cancer?
β-hCG and α-fetoprotein (αFP)
How do testicular tumor markers decrease with metastatic therapy?
logarithmically with each cycle
Besides testicular cancer, when can AFP be increased?
hepatocellular carcinomas and cirrhosis
Besides testicular cancer, when can β-hCG levels be increased?
- prostate, bladder, and ureteral cancers
- marijuana abuse
What’s the typical initial intervention for testicular cancer?
radical inguinal orchiectomy
The testes are considered a “sanctuary site”. What does this mean?
chemotherapy poorly penetrates this area
What is the recommended course of treatment for stage IA/IB seminomatous testicular cancer?
- radical orchiectomy
- surveillance or radiation or carboplatin for 1-2 cycles
What is the recommended course of treatment for stage IIA/IIB seminomatous testicular cancer?
- radical orchiectomy
- radiation to include iliac lymph nodes or BEP x 3 cycles or EP x 4 cycles
What is the recommended course of treatment for stage IIC/III seminomatous testicular cancer?
- radical orchiectomy
- BEP x 3 cycles or EP x 4 cycles if good risk, BEP x 4 or VIP x 4 if intermediate risk
What is the recommended course of treatment for stage IA/IB non-seminomatous testicular cancer?
- radical orchiectomy
- surveillance or RPLND or BEP x 1 cycle
What is the recommended course of treatment for stage IIA/IIB non-seminomatous testicular cancer?
- radical orchiectomy
- RPLND or BEP x 3 cycles or EP x 4 cycles
What are the preferred regimens for testicular cancer salvage therapy?
VeIP and TIP
What is in a BEP regimen?
bleomycin, etoposide, cisplatin
What is in a VIP regimen?
etoposide, ifosfamide (+ mesna), cisplatin
What is in a VeIP regimen?
vinblastine, ifosfamide (+ mesna), cisplatin
What can be used after a testicular cancer patient progresses on HDC?
gemcitabine, paclitaxel, etoposide, oxaliplatin, irinotecan
What drug could be used in a testicular cancer patient who is deficient in MMR/MSI?
pembrolizumab
