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Fall 2021: Therapeutics III > Therapeutics of Testicular Cancer (Weddle) > Flashcards

Therapeutics of Testicular Cancer (Weddle) Flashcards

1
Q

What race is more likely to develop prostate cancer?

A

those murderous whites

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2
Q

What is the precursor lesion for invasive germ cell tumors of testicular cancer?

A

carcinoma in situ (CIS)

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3
Q

More than 95% of testicular cancers are _____________ tumors.

A

germ cell

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4
Q

What are the two histologic types of germ cell tumors?

A

seminoma and non-seminoma

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5
Q

What hormone do seminomas secrete?

A

β-hCG only

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6
Q

What hormones do non-seminomas secrete?

A

β-hCG and α-fetoprotein (αFP)

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7
Q

Which type of germ cell tumor is most common in the 4th decade of life?

A

seminoma

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8
Q

Which type of germ cell tumor has 4 major histopathologic subtypes?

A

non-seminoma

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9
Q

How should we treat a tumor that has both seminomatous and non-seminomatous elements?

A

treat as if it is non-seminomatous (the more aggressive one)

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10
Q

What is the only known predisposing factor for testicular cancer?

A

cryptorchidism

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11
Q

What is the most common symptom of testicular cancer (not advanced)?

A

painless mass in the testis

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12
Q

How may advanced testicular cancer present?

A
  • Abdominal pain
  • Back pain
  • Change in bladder/bowel habits
  • Nausea/vomiting
  • Altered mental status
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13
Q

Where can left-sided testicular tumors spread to?

A

left para-aortic, pre-aortic, and inter-aortocaval lymph nodes

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14
Q

Where can right-sided testicular tumors spread to?

A

right pre-aortic, pre-caval, and inter-aortocaval lymph nodes

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15
Q

True or false: most testicular cancer patients will present with stage II disease

A

hell nah; 70% stage I

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16
Q

Why should you NEVER do a needle biopsy in the scrotum?

A

can contaminate the retroperitoneal lymph nodes resulting in metastatic disease

17
Q

What tumor markers can help classify whether a patient is good-, intermediate-, or poor-risk for testicular cancer?

A

β-hCG and α-fetoprotein (αFP)

18
Q

How do testicular tumor markers decrease with metastatic therapy?

A

logarithmically with each cycle

19
Q

Besides testicular cancer, when can AFP be increased?

A

hepatocellular carcinomas and cirrhosis

20
Q

Besides testicular cancer, when can β-hCG levels be increased?

A
  • prostate, bladder, and ureteral cancers
  • marijuana abuse
21
Q

What’s the typical initial intervention for testicular cancer?

A

radical inguinal orchiectomy

22
Q

The testes are considered a “sanctuary site”. What does this mean?

A

chemotherapy poorly penetrates this area

23
Q

What is the recommended course of treatment for stage IA/IB seminomatous testicular cancer?

A
  1. radical orchiectomy
  2. surveillance or radiation or carboplatin for 1-2 cycles
24
Q

What is the recommended course of treatment for stage IIA/IIB seminomatous testicular cancer?

A
  1. radical orchiectomy
  2. radiation to include iliac lymph nodes or BEP x 3 cycles or EP x 4 cycles
25
Q

What is the recommended course of treatment for stage IIC/III seminomatous testicular cancer?

A
  1. radical orchiectomy
  2. BEP x 3 cycles or EP x 4 cycles if good risk, BEP x 4 or VIP x 4 if intermediate risk
26
Q

What is the recommended course of treatment for stage IA/IB non-seminomatous testicular cancer?

A
  1. radical orchiectomy
  2. surveillance or RPLND or BEP x 1 cycle
27
Q

What is the recommended course of treatment for stage IIA/IIB non-seminomatous testicular cancer?

A
  1. radical orchiectomy
  2. RPLND or BEP x 3 cycles or EP x 4 cycles
28
Q

What are the preferred regimens for testicular cancer salvage therapy?

A

VeIP and TIP

29
Q

What is in a BEP regimen?

A

bleomycin, etoposide, cisplatin

30
Q

What is in a VIP regimen?

A

etoposide, ifosfamide (+ mesna), cisplatin

31
Q

What is in a VeIP regimen?

A

vinblastine, ifosfamide (+ mesna), cisplatin

32
Q

What can be used after a testicular cancer patient progresses on HDC?

A

gemcitabine, paclitaxel, etoposide, oxaliplatin, irinotecan

33
Q

What drug could be used in a testicular cancer patient who is deficient in MMR/MSI?

A

pembrolizumab

Fall 2021: Therapeutics III (25 decks)

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