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Development > Bone Pain And Testicular Lump > Flashcards

Bone Pain And Testicular Lump Flashcards

1
Q

why is bone pain associated with prostate cancer?

A

prostate cancer is prone to spread in the axial skeleton owing to its lymphatic drainage (para-aortic nodes) -> it causes OSTEOSCLEROSIS

(lung/breast cancers are lytic)

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2
Q

what is the most common type of testicular cancer

A

95% of testicular cancers are germ cell tumours:

Seminomas (most common) & Teratomas

Teratomas (20-30) tend to present in slightly younger men than seminomas (30-40)

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3
Q

list some risk factors for TGCT

A

cryptorchism
testicular atrophy
inguinal hernia
hydrocele
syndromes of abnormal testicular development (Klinefelter’s, XY dysgenesis, Down’s)
? genetic involvment - monozygotic > dizygotic - no gene identified so far

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4
Q

which genes/ chroosomal changes have been implicated in TGCTs

A

probably more than one genetic locus
p53
RB

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5
Q

list some testicular atrophic events

A
  1. cryptorchism
  2. chemicals (oestrogens in pesticides, solvents - dimethylformamide)
  3. trauma
  4. idiopathic
  5. viruses - mumps
  6. other infective agents
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6
Q

what percentage of CIS in the testes will be invasive by 5 years

A

50%
spontaneous disappearance is never observed!
Untreated probably all invasive eventually

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7
Q

why should all men presenting with gynaecomastia have a testicular exam

A

5% of testicular cancers present with gynaecomastia

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8
Q

which tumour markers are investigated in testicular cancer

A

AFP
beta-hCG
LDH
(NSE and CEA)

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9
Q

what might a seminoma display on tumour marker tests

A

raised LDH
mildy raised HCG
NEVER raised AFP

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10
Q

what might a teratoma display on tumour marker tests

A

80% will express raised AFP or HCG

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11
Q

what is alpha fetoprotein

A

embryonal protein produced by the yolk sac and foetal liver
marker of hepatocellular carcinoma and non-seminomatous tumours
NOT produced by pure seminomas

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12
Q

what is rising LDH an indicator of in testicular cancer

A

relapse

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13
Q

under what circumstances should a contralateral testicular biopsy be done

A
  • testicular volume <30 years old
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14
Q

what would be the management for stage one seminoma

A

orchidectomy plus adjuvant chemo/radiotherapy as 15-20% relapse if orchidectomy alone

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15
Q

what is the management of stage I NSGCT dependant on

A

vascular invasion - if positive need adjuvant chemo

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16
Q

what management options are available for metastatic seminoma

A

radiotherapy - dog leg

Chemo- PEB/

17
Q

what are the management options for metastatic NSGCT

A

chemo unless raised tumour markers and/or nerve sparing retroperitoneal lymph node dissection

18
Q

list some differentials for intra-testicular masses

A 
generally malignant:
malignant primary tumours
malignant secondaries (old lymphoma, children leukaemia)
benign tumours -> epidermoid
Infection
Trauma
Torsion
19
Q

extra-testicular masses are much more common, list some differentials

A 
Hydrocoele
Epididymal cysts
Spermatocoeles
Varicocoele
Epididymitis/orchitis
20
Q

which nodes are involved in advance penile carcinoma

A

inguinal nodes

21
Q

Penile cancer

A

relatively rare squamour cell carcinoma usually from inner prepuc and glans

22
Q

what are the risk factors associated with penile cancer

A 
not being circumcised (poor penile hygeine)
HPV - 50% associated
Genital warts
smoking
Psoralen and UVA
Penile injury
23
Q

what are the definitive risk factors of prostate cancer

A

Age
Race
Family history

24
Q

in the UK and US which ethnicities are a more risk for prostate cancer

A

black males have a higher risk than Whites
Chinese and Janapese have lowest incidence

geographical variations as well:
- higher in north america and europe
- lowest in far east
Migration changes risk within 2 generations

25
Q

which gene is associated with increased risk of prostate cancer

A

BRCA2 increases risk 5x
2.1-4.9 times higher in those with Lynch syndrome
10% of prostate cancer has a genetic base

26
Q

which LUTs are associated with prostate cancer

A
  • obstructive voiding
  • irritative symptoms
  • haemospermia
  • impotence
27
Q

what symptoms of locally advanced disease might be present in prostate cancer

A

bony pain
anaemia
lymphoedema
renal failure

28
Q

what are the indications for a PSA test

A
  • LUTS suggestive of BPH
  • abnormal prostate on DRE
  • patient concerned about prostate cancer
29
Q

under what circumstances should a PSA NOT be performed

A

retention/infection
<10 year life expectancy
following instrumentation to the lower urinary tract

PSA is also increased following: ejaculation, cycling, BPH, prostatic biopsy, prostatitis, prostatic massage,

30
Q

which investigations are used to detect prostate cancer

A
  1. DRE
  2. PSA
  3. TRUS biopsy
31
Q

which scale is commonly used to grade pathology

A

Gleasons pattern scale

32
Q

how are prostate cancers staged?

A

TNM
clinically - DRE
Radiologically - CT/MRI

33
Q

what curative therapies are available to men with localised prostate cancer

A

surgery
radiotherapy
adjuvant hormones

34
Q

what therapies are available to men with locally advanced disease

A

surgery + neoadjuvant hormone therapy
radiotherapy and hormone therapy
hormone therapy

35
Q

what therapies are available to men with metastatic prostate cancer

A

hormones
chemotherapy
osteoprotective medications
steroids

36
Q

what is a theory behindthe pathogenesis of BPH

A

stromal-epithelial interaction leading to embryonic awakening

37
Q

presentation of BPH

A 
frequency of urination (nocturia)
hesitation
post void dribbling
retention/overflow incontinence
smooth on DRE
38
Q

what methods are available for hormone deprivation in the treatment of prostate cancer

A

GnRH analogues
Androgen receptor blockers (block CYP17)
Surgical castration (orichidectomy)

Development (13 decks)

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