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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
What type of secondary malignancy has an increased risk with radiotherapy
Solid organ malignancy
26
What type of secondary malignancy has an increased risk with chemotherapy
Haemotological malignancy
27
What 3 drugs are given as adjuvant chemotherapy in testicular cancer
1. Bleomycin 2. Etoposide 3. Cisplatin
28
Complications of Bleomycin
1. Pneumonitis | 2. Pulmonary fibrosis
29
Complications of Cisplatin
1. Renal impairment 2. Neuropathy, high tone hearing loss 3. Vomiting 4. Increased risk of MI, stroke
30
Do males or females have more fertility complications after treatment for germ cell tumours
Females
31
Which tumour marker is particularly associated with SEMINOMA
b-hCG
32
Which tumour marker is particularly associated with EMBRYONAL CARCINOMA
b-hCG + AFP
33
Which tumour marker is particularly associated with YOLK SAC TUMOUR
AFP
34
Which tumour marker is particularly associated with CHORIOCARCINOMA
b-hCG
35
Describe how a seminoma will mets - mode - route
Lymphatics para-aortic nodes -> pelvic nodes -> mediastinal nodes
36
Which cancer has transcolemic spread? Where to?
Ovarian cancer Spread to lung liver bone
37
False positive for hCG
Cannabis
38
False positive for AFP
Alcohol abuse
39
Features of tumour lysis syndrome -electrolytes
High uric acid High postassium High phosphate Low calcium

Stage 4: CSIM 2 (47 decks)

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