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Stage 4: CSIM 2 > Week 9: Germ cell tumours > Flashcards

Week 9: Germ cell tumours Flashcards

1
Q

How might testicular cancer present

A
  1. Painless solid enlargement
  2. Decrease in testicular size
  3. Scrotal pain (dragging sensation)
  4. Hydrocele
  5. Gynaecomastia
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2
Q

Does testicular cancer present early or late

A

Late

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3
Q

Differential diagnosis for a testicular mass

A
  1. Cancer
  2. Benign epididymal mass (common)
  3. Orchitis/ epididymo-orchitis
  4. Infiltration from lymphoma/ leukaemia
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4
Q

Which elevated tumour markers, in conjuction with a testicular mass, is highly suggestive of testicular cancer

A
  1. AFP

2. beta hCG

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5
Q

What investigations should be done for testicular cancer

A
  1. Tumour markers (AFP and b-hCG)
  2. Scrotal USS
  3. CXR
  4. CT chest, abdo, pelvis
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6
Q

When would you do a CT brain in a pt with testicular cancer

A
  1. Multiple lung mets

2. b-hCG >10,000

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7
Q

Why do pts with high b-hCG have a risk of getting thyrotoxicosis

A

b-hCG is similar in structure to TSH

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8
Q

Where is b-hCG formed in body

A

Syncytiotrophoblast (in placenta)

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9
Q

What type of tumours is b-hCG elevated in

A
  1. Germ cell tumours

2. Gestational trophoblastic disease

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10
Q

Where is AFP formed in body

A
  1. Liver
  2. Intestine
  3. Foetal yolk sac
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11
Q

What type of tumours is AFP elevated in (2 most impt)

A

Most impt :

  1. Teratomas
  2. Hepatocarcinoma

Others:

  1. Pancreatic cancer
  2. Biliary cancer
  3. Gastric cancer
  4. Bronchial cancer
  5. Non-malignant liver disease
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12
Q

Approximately how long after surgery should AFP and b-hCG take to normalise

A

b-hCG: 24h
AFP: 4-6 days

AFP has a longer half life so takes longer to normalise

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13
Q

What type of tumours is Lactate Dehydrogenase elevated in

A

Any rapid-growing tumour (indicates that necrosis is occurring)

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14
Q

Seminoma/ Teratoma has a more predictable lymphatic spread

A

Seminoma has a more predictable lymphatic spread

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15
Q

Seminoma/ Teratoma is more commonly spread through blood

A

Teratoma is more commonly spread through blood

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16
Q

In local spread of testicular cancer, where are the mets found

A

Rete testis (in both types of testicular cancer)

17
Q

Most common site that a blood-spread testicular tumour goes to

18
Q

Which chromosomal syndromes are associated with a higher risk of testicular cancer

A
  • Klinefelter’s syndrome

* Down’s syndrome

19
Q

Complications of local/ distal mets in testicular cancer

A
  1. SVC obstruction
  2. Ureteric obstruction
  3. Pleural effusion
  4. Lung, brain, liver mets
20
Q

Paraneoplastic complications of testicular cancer

A
  1. Pulmonary emboli

2. Tumour lysis syndrome

21
Q

How are the levels of the following in blood changed in tumour lysis syndrome

  • uric acid
  • K+
  • Ca2+
  • phosphate
A
  • uric acid HIGH
  • K+ HIGH
  • Ca2+ LOW
  • phosphate HIGH
22
Q

How does tumour lysis syndrome affect the heart/vascular system

A
  1. Cardiac arrest, arrhythmias (due to high K+, low Ca2+)
  2. Intravascular haemolysis (due to high LDH)
  3. More clots (activation of coagulation cascades)
23
Q

How does tumour lysis syndrome affect the kidney

A

Urate nephropathy (due to high uric acid in blood)

24
Q

Do teratomas or seminomas have a higher relapse rate

25
Q

What type of secondary malignancy has an increased risk with radiotherapy

A

Solid organ malignancy

26
Q

What type of secondary malignancy has an increased risk with chemotherapy

A

Haemotological malignancy

27
Q

What 3 drugs are given as adjuvant chemotherapy in testicular cancer

A
  1. Bleomycin
  2. Etoposide
  3. Cisplatin
28
Q

Complications of Bleomycin

A
  1. Pneumonitis

2. Pulmonary fibrosis

29
Q

Complications of Cisplatin

A
  1. Renal impairment
  2. Neuropathy, high tone hearing loss
  3. Vomiting
  4. Increased risk of MI, stroke
30
Q

Do males or females have more fertility complications after treatment for germ cell tumours

31
Q

Which tumour marker is particularly associated with SEMINOMA

32
Q

Which tumour marker is particularly associated with EMBRYONAL CARCINOMA

A

b-hCG + AFP

33
Q

Which tumour marker is particularly associated with YOLK SAC TUMOUR

34
Q

Which tumour marker is particularly associated with CHORIOCARCINOMA

35
Q

Describe how a seminoma will mets

  • mode
  • route
A

Lymphatics

para-aortic nodes -> pelvic nodes -> mediastinal nodes

36
Q

Which cancer has transcolemic spread?

Where to?

A

Ovarian cancer

Spread to lung liver bone

37
Q

False positive for hCG

38
Q

False positive for AFP

A

Alcohol abuse

39
Q

Features of tumour lysis syndrome

-electrolytes

A

High uric acid
High postassium
High phosphate
Low calcium

Stage 4: CSIM 2 (47 decks)

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