Germ Cell

Question 1

Why can men develop gynae Onassis when they have a testicular cancer?

Answer 1

If BHCG is raised

Question 2

What investigations should be performed for a testicular mass?

Answer 2

Bilateral testicular USS
BHCG
AFP
LDH
CT TAP
MR brain (if choriocarcinoma or poor prognostic group)
Sperm banking (HIV, Hep b&c, syphilis screen)
Biopsy usually from the radical inguinal orchidectomy

Question 3

What distinguishes T1 and T2?

Answer 3

Both limited to testis and epididymis but T2 if has vascular/lymphatic invasion or involvement of tunica vaginalis

Question 4

Describe N1

Answer 4

<=5LN all <=2cm

Question 5

Describe N2

Answer 5

2-5cm
Or
>5LNn all <5cm

Question 6

Describe N3

Answer 6

> 5cm

Question 7

What TNM is stage 1?

Answer 7

AnyT N0 S1-3

Question 8

What is classed as a high risk stage 1 seminoma?

Answer 8

Size >4cm or rete testis involvement

If neither of these risk of recurrence ~10%
If one of these risk is ~15%
If both, 30%

Question 9

What is the preferred treatment option for stage 1 seminoma with high risk features?

Answer 9

Carboplatin AUC7 x 1

Or

20Gy/10# para-aortic XRT

Question 10

Define the field borders for para-aortic XRT

Answer 10

Sup: bottom of T10
Inf: bottom of L5
Lateral: border to edge of renal hilum

Question 11

Define stage IIA

Answer 11

Tany N1 M0 S0-1