NCCN Testicular 3.2020 Flashcards Preview

EAMC Urology > NCCN Testicular 3.2020 > Flashcards

Flashcards in NCCN Testicular 3.2020 Deck (68)
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1

Initial workup
Suspicious testicular mass

H and PE
AFP, beta-HCG, LDH
Chemistry profile (baseline gonadal function)
Testicular ultrasound


TEST-1

2

Primary treatment
Suspicious testicular mass

Radical inguinal orchiectomy
Sperm banking
Consider INGUINAL biopsy
Consider testicular prosthesis


TEST-1

3

Indications for inguinal biopsy of contralateral testis

Ultrasound: intratesticular mass concerning for testicular CA
Cryptorchid testis
Marked atrophy
Suspicious mass


TEST-1

4

Postdiagnostic workup
Pure seminoma (pure seminoma histology + AFP normal, -/+ elevated beta-HCG

Abdominal pelvic CT
CXR --> Chest CT if (+) abd. CT or CXR
Post-orchiectomy beta-HCG, LDH, and AFP
Brain MRI, if indicated
Sperm banking


TEST-2

5

Is TNM staging based on post or pre orchiectomy values of tumor markers?

TNM staging is based on POST-ORCHIECTOMY values of tumor markers.


TEST-1

6

Primary treatment: Pure seminoma
IA, IB

Surveillance for pT1-pT3 tumors (strongly preferred)
OR
Single-agent carboplatinp,q
(AUC=7 x 1 cycle or AUC=7 x 2 cycles)
OR
RT (20 Gy or 25.5 Gy)


TEST-3

7

Primary treatment: Pure seminoma
IS

Repeat elevated serum tumor marker measurement and asses with chest/abdominal/pelvic CT (with contrast) to scan for evaluable disease


TEST-3

8

Primary treatment: Pure seminoma
IIA

RT to include para-aortic and ipsilateral iliac lymph nodes to a dose of 30 Gy
OR
Primary chemotherapy
BEP for 3 cycles or EP for 4 cycles



TEST-4

9

Primary treatment: Pure seminoma
IIB

Primary chemotherapy
BEP for 3 cycles or EP for 4 cycles
OR
RT in select non-bulky (≤3 cm) cases to include para-aortic and ipsilateral iliac lymph nodes to a dose of 36 Gy


TEST-4

10

Primary treatment: Pure seminoma
IIC, III
Good risk

Primary chemotherapy
BEP for 3 cycles (cat 1)
OR
EP for 4 cycles (cat 1)


TEST-4

11

Primary treatment: Pure seminoma
IIC, III
Intermediate risk

Primary chemotherapy
BEP for 4 cycles (cat 1)
OR
VIP for 4 cycles (cat 1)


TEST-4

12

Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Imaging: no residual mass, or =< 3 cm
Markers: normal AFP, beta-HCG

Surveillance



TEST-5

13

Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Imaging: Residual mass, > 3 cm
Markers: normal AFP, beta-HCG

Surveillance
OR
Consider PET/CT scan from skull base to mid- thigh (6 wks
or more post- chemotherapy)
- If (+), resect residual mass or biopsy, then if (+) viable seminoma with complete resection --> 2 cycles of adjuvant chemo
- If incomplete resection: second line chemo


TEST-5

14

Primary treatment: Pure seminoma
After primary chemotherapy
IIA-IIC, III
Progressive disease: rising tumor markers, growing mass

Second-line therapy:

Clinical trial (preferred)
Chemotherapy
- Conventional-dose therapy (VeIP or TIP)
- High-dose chemotherapy
Consider surgical salvage if solitary site (for early relapse)
Recommend sperm banking if clinically indicated


TEST-5, TEST-13

15

Primary treatment: NSGCT
Post-diagnostic workup

Chest/abdominal/pelvic CT
Repeat beta-HCG, LDH, AFP
Brain MRI if indicated
Sperm banking


TEST-6

16

Primary treatment: NSGCT
Stage I WITHOUT risk factors

Surveillance (preferred)
OR
Nerve-sparing RPLND
OR
Primary chemotherapy: BEP x 1 cycle


TEST-7

17

Primary treatment: NSGCT
Stage I WITH risk factors

Surveillance
OR
Primary chemotherapy: BEP x 1 cycle
OR
Nerve-sparing RPLND


TEST-7

18

Primary treatment: NSGCT
Stage IS

Check for persistent marker elevation
---
Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)


TEST-8

19

Primary treatment: NSGCT
Stage IIA, markers negative

Nerve-sparing RPLND
OR
Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles


TEST-8

20

Primary treatment: NSGCT
Stage IIA, persistent marker elevation

Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)


TEST-11

21

Primary treatment: NSGCT
Stage IIB, markers negative , LN mets within lymphatic drainage sites

Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles
or
Nerve-sparing RPLND in highly selected cases


TEST-8

22

Primary treatment: NSGCT
Stage IIB, markers negative , multifocal symptomatic or LN mets with aberrant lymphatic drainage

Primary chemotherapy:
BEP for 3 cycles or EP for 4 cycles



TEST-8

23

Primary treatment: NSGCT
Stage IIB, persistent marker elevation

Primary chemotherapy:
BEP for 3 cycles (category 1)
or
EP for 4 cycles (category 1)


TEST-11

24

Postchemotherapy management: NSGCT
Stage IIA, IIB
Negative markers, residual mass (≥1 cm) on CT scan

Nerve-sparing bilateral RPLND


TEST-9

25

Postchemotherapy management: NSGCT
Stage IIA, IIB
Negative markers, no mass, or residual mass <1 cm on CT scan

Surveillance
OR
Nerve-sparing bilateral RPLND in selected cases (category 2B)


TEST-9

26

Postsurgical management: NSGCT
Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND

pN0

Surveillance



TEST-10

27

Postsurgical management: NSGCT
Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND

pN1

Surveillance (preferred) or
Chemotherapy:
BEP for 2 cycles
or
EP for 2 cycles


TEST-10

28

Postsurgical management: NSGCT
Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND

pN2

Chemotherapy (preferred):
BEP for 2 cycles
or
EP for 2 cycles or
Surveillance



TEST-10

29

Postsurgical management: NSGCT
Stage I with or without risk factors, IIA, IIB treated with primary nerve-sparing RPLND

pN3

Chemotherapy:
BEP for 3 cycles
or
EP for 4 cycles




TEST-10

30

Primary treatment: NSGCT
Intermediate risk
Stage IIIB

Primary chemotherapy:
BEP for 4 cycles (category 1)
or
VIP for 4 cycles
(category 1)


TEST-11