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Urology > B/10. Testicular tumors > Flashcards

B/10. Testicular tumors Flashcards

(42 cards)

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1
Q

Epidemiology of testicular tumors

A
  • Cancer of young men (age at presentation usually 18-35 years)
  • Caucasians > African-American
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2
Q

Cancer of young men

A

testicular tumors
18-35 years)

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3
Q

Risk factors for testicular tumors

A
  • Cryptorchidism (abdominal cryptorchid testis > inguinal cryptorchid testis) : strongest risk factor
  • Family history
  • Klinefelter syndrome
  • Tumor of contralateral testis
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4
Q

what can reduce the risk of germ cell tumors and improves the ability to save the testis

A

Early orchiopexy

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5
Q

abdominal cryptorchid testis that cannot be brought into the scrotum should be

A

removed.

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6
Q

Clinical findings in testicular tumors

A
  • Painless testicular mass in young men is pathognomonic for a testicular malignancy.
  • The mass does not transilluminate (differential : hydrocele)
  • More commonly, patients present with testicular discomfort or swelling suggestive of
    epididymitis and/or orchitis.
    In this circumstance, a trial of antibiotics is reasonable
  • However, if symptoms persist or a residual abnormality remains: testicular US is indicated
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7
Q

differential between hydrocele and testicular tumor

A

tumor mass does not transilluminate

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8
Q

Testicular tumors diagnostic

A
  • However, if symptoms persist or a residual abnormality remains: testicular US is indicated
  • If a testicular mass is detected, a radical inguinal orchiectomy should be performed
  • Biopsy is contraindicated!
  • serum level of alpha-fetoprotein (AFP), hCG, and LDH should be measured
  • CT scan of the chest, abdomen, and pelvis is indicated after orchiectomy
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9
Q

can u take biopsy of testicular lesion?

A

Biopsy contraindicated!!!!!

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10
Q

labs to be checked in suspicioun of testicular tumor

A
  • serum level of alpha-fetoprotein (AFP),
  • hCG, and
  • LDH should be measured
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11
Q

When is CT indicated in testicular tumors?

A

CT scan of the chest, abdomen, and pelvis is indicated
after orchiectomy

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12
Q

If a testicular mass is detected what should be performed?

A

radical inguinal orchiectomy

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13
Q

Signs and symptoms due to metastatic testicular cancer

A
  • back pain from retroperitoneal metastases,
  • dyspnea due to lung metastases (less common), and
  • gynecomastia due to tumors producing hCG.
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14
Q

Testicular mass in mass in male above or equal to 50 years should be regarded as

A

lymphoma until proven otherwise

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15
Q

pathology of testicular tumors

A
  • Germ cell tumors (>95%):
    *Seminoma
    *Non-seminoma: Endodermal sinus (yolk sac) tumor, Choriocarcinoma, Embryonal carcinoma, Teratoma
  • Non-germ cell tumors ( < 5%)
    *Sertoli cell tumor : Mostly benign
    *Leydig cell tumor :Mostly benign
    *Testicular lymphoma
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16
Q

Most common testicular tumor

A

Seminoma

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17
Q

Seminoma prognosis

Study These Flashcards
A
    • Most common testicular tumor (50%)
  • Tends to metastasize late, good prognosis
18
Q

Non-seminoma

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A
  • Endodermal sinus (yolk sac) tumor: Tumor secretes AFP, Aggressive
  • Choriocarcinoma: tumor secretes beta-hCG, May present with gynecomastia and symptoms of hyperthyroidism
  • Embryonal carcinoma : Painful, hemorrhagic mass with necrosis
  • Teratoma: Usually malignant (compared with female teratoma)

learn the names onlys in this flashcard

19
Q

Endodermal sinus
(yolk sac) tumor

is it good or aggressive ?

Study These Flashcards
A

Tumor secretes AFP
- Aggressive Non-seminoma

non seminoma germ cell tumor

20
Q

Choriocarcinoma

what does it present with

Study These Flashcards
A
  • tumor secretes beta-hCG
  • May present with gynecomastia and
    symptoms of hyperthyroidism

non seminoma germ cell tumor

21
Q

Embryonal carcinoma feature

Study These Flashcards
A

Painful, hemorrhagic mass with necrosis

non seminoma germ cell tumor

22
Q

Teratoma
is it malignant or benign?

Study These Flashcards
A

Usually malignant (compared with female
teratoma)

non seminoma germ cell tumor

23
Q

Non-germ
cell tumors

Study These Flashcards
A

(< 5%)
* Sertoli cell tumor Mostly benign
* Leydig cell tumor Mostly benign
* Testicular lymphoma
-Most common testicular cancer in older men
-Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)

24
Q

-Most common testicular cancer in older men

Study These Flashcards
A

Testicular lymphoma

-Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)

25
is testicular lymphoma usually a primary testicular disease?
Not a 1° testicular disease, arises from a metastatic lymphoma (usually diffuse large B-cell)
26
Germ cell tumors (>95%)
* Seminoma * Non-seminoma: *Endodermal sinus (yolk sac) tumor *Choriocarcinoma *Embryonal carcinoma *Teratoma
27
Staging of testicular tumor is based on
Based on the American Joint Committee on Cancer (AJCC) groups, which combines TNM stage and serum tumor marker levels
28
Staging of testicular tumor
T1 Disease is limited to the testis, epididymis, no LN involvement T2 Disease is limited to the retroperitoneal (regional) LNs (paraaortic nodes) T2a Affected LN < 2 cm T2b Affected LN 2-5 cm T2c Affected LN > 5 cm T3 Disease outside the retroperitoneum, involving supradiaphragmatic nodal sites or viscera (metastases); with moderately to highly elevated tumor markers
29
Treatment of testicular tumors
* Prior to surgery: sperm cryopreservation * Radical inguinal orchiectomy * Adjuvant radiotherapy and chemotherapy
30
adjuvant Treatment of seminomas Following radical inguinal orchiectomy T1, T2, T3
* T1: *active surveillance OR *chemotherapy (carboplatin) OR *Radiation therapy of regional LNs * T2: *Radiation therapy *CHEMO: BEP1 (bleomycin, etoposide, and cisplatin) or EP ( etoposide, cisplatin) * T3: chemo (full dose, not adjuvant) +/- resection of any residual disease focus
31
active surveillance in testicular tumors
Regular follow-up appointments with physical examination, chest x-ray , and abdominopelvic CT scan.
32
Treatment of non-seminoma testicular tumor
* radical inguinal orchiectomy * adjuvant treatment (after surgery)
33
adjuvant treatment of non-seminoma stage 1
* Active surveillance or * RPLND3 ± cisplatin-based chemotherapy * Chemotherapy: BEP
34
adjuvant treatment of non-seminoma stage 2
* In patients with normal post-orchiectomy tumor markers: RPLND3 ± cisplatin-based chemotherapy * In patients with elevated post-orchiectomy tumor markers: chemotherapy with BEP1or EP2
35
adjuvant treatment of non-seminoma stage 3
Chemotherapy (depending on prognosis): BEP1 or EP2 followed by evaluation of any residual disease that may require resection
36
RPLND (retroperitoneal lymph node dissection) what is it
the standard procedure for removal of the regional lymph nodes of the testis (retroperitoneal nodes). * removes the **LNs draining the primary site and the nodal groups adjacent to the primary landing zone.** * The standard (modified bilateral) RPLND removes **all node-bearing tissue down to the bifurcation of the great vessels, including the ipsilateral iliac nodes.** * The major long-term effect of this operation is retrograde ejaculation with resultant infertility. Nervesparing RPLND can preserve anterograde ejaculation in 90% of patients
37
The major long-term effect of RPLND operation
is retrograde ejaculation with resultant infertility. Nervesparing RPLND can preserve anterograde ejaculation in 90% of patients
38
Chemotherapy used for testicular tumors
* 1st line: bleomycin, etoposide, cisplatin * 2nd line: vinblastine, ifosfamide
39
short term side effects of chemotherapy for testicular tumors
* alopecia * myelosupression * neutropenia * sepsis * severe N/V
40
Longterm SE of Cisplatin
* nephrotoxicity, * ototoxicity, * peripheral neuropathy, * infertility (germ cell damage
41
Long- term SE of bleomycin
pulmonary fibrosis
42
what should be recommended to all patients before treatment of testicular tumor?
Semen analysis and cryopreservation

Urology (30 decks)

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