UROLOGY Flashcards
prostate cancer tests
alkaline
phosphatase,
prostatic specific antigen,
bone scan.
Markers that maybe positive in seminoma
LDH - high-level infers advanced disease
Only 25% positive Beta hCG
“semen causes pregnancy some of the time”
NO AFP
“semen is not for babies”
Markers that maybe positive and non-seminal germ cell tumor
Beta hCG
AFP
LDH - suggest more advanced disease
Adjuvant therapy for seminoma
Very sensitive to XRT
possible use of chemo
What is chemotherapy for non-seminomatous germ cell tumors
Bleomycin
“Lance Armstrong”
Cis-platinum
“Testicles are platinum cysts”
germ cell tumors list
Most common:
Leydig
Sertoli cell
other malignant lesions besides a germ cell tumors
lymphoma metastatic lesions Mumps Infection Lymphoma
Nonseminomatous tumor types include
embryonal carcinoma,
yolk sac tumor (presenting in infants and children),
choriocarcinoma,
teratoma;
–germ cell tumors risk of malignancy
usually nonmalignant;
less than 10% of Leydig or Sertoli cell tumors are considered malignant.
Risk factors for the development of germ cell tumors
greatest with the intra-abdominal undescended testis
cryptorchidism.
lower risk, but still elevated, in testes located in a groin position.
Various intersex abnormalities are also risk factors for germ cell tumor.
HIV infection is thought to be a risk factor for testicular cancer.
It is controversial whether testicular atrophy of a benign cause elevates germ cell tumor risk.
Work up of scrotal mass
Any scrotal mass lesion that cannot be definitively determined to be benign on physical examination should undergo scrotal
ultrasound.
Patients who have a hydrocele or other cystic lesion of the scrotal contents should also undergo ultrasound if the testis cannot be definitively palpated and determined to be entirely normal.
Constitutional symptoms that may be present with metastatic testicular cancer
back pain,
pulmonary symptoms,
weight loss,
abdominal mass.
Neuro
Metastatic disease from testicular cancer
predictable retroperitoneal lymphatic path
right testis, initial To:
periCAVAL
and
interaortocaval
left, to
left para-AORTA nodes,
and then on to other retroperitoneal nodal levels on either side.
Distant metastases: lung, liver, brain, bone, kidney, adrenal
The likelihood of a man’s presenting with metastatic disease is approximately 20% for seminoma and higher (30% to 60%) with nonseminomatous tumors
(choriocarcinoma is notorious for hematogenous spread early to distant sites AND NEED BRAIN MRI)
Testis tumor patients should be worked up how
scotal US
tumor markers
CT chest, abd, pelv
pos:
bone scan
Head
AND
Testis tumor patients should undergo COPMPLETE metastatic evaluation
(becuase 20-40% present metastatic)
tumor markers:
(β-human chorionic gonadotropin [hCG] (pos 25% sem)
alpha-fetoprotein [AFP] (NEVER pos for sem - “not for babies”)
Lactate dehydrogenase [LDH])
CT:
chest, abdomen, and pelvis, preferably prior to orchiectomy to avoid postsurgical artifacts.
based on suspicion (or ALL choriocarcinomas):
Bone and/or brain imaging
The standard initial treatment for testicular tumors is
radical inguinal orchiectomy
groin incision
with mobilization of the spermatic cord from within the inguinal canal
mobilization of the testis from the scrotum
keep intact parietal tunica vaginalis sac. It
(enter the tunica vaginalis inadvertently can spill tumor)
Ligate spermatic cord high at the level of the internal inguinal ring;
marking suture should be left
