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Repro / GU > SM_228b: Testis Cancer > Flashcards

SM_228b: Testis Cancer Flashcards

(49 cards)

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1
Q

Describe the anatomy of the testis

A

Testis anatomy

  • Covered by tunica albuginea
  • Arterial supply: testicular artery (from aorta), vasal artery (from superior vesical arrery)
  • Venous return: pampiniform plexus -> gonadal vein, right -> IVC, left -> renal vein
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2
Q

This is testis undergoing ____

A

This is testis undergoing spermatogenesis

  • Spermatogonia -> spermatocytes -> spermatids -> spermatozoa
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3
Q

This is a ___ found in ___ that is responsible for ___

A

This is a Crystal of Reinke found in Leydig cells that is responsible for hormone production

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4
Q

Describe the epidemiology of testicular cancer

A

Epidemiology of testicular cancer

  • Most common between age 15-35
  • 95% of germ cell origin while 5% are Leydig, Sertoli cell, and other variants
  • 2-3% incidence of bilateral tumors
  • Incidence has increased 50% over the last 20-30 years in Caucasian and Hispanics
  • Relatively uncommon in Asians and very rare in African Americans
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5
Q

Describe epidemiology of bilateral testis tumors

A

Bilateral testis tumors

  • 1-4% incidence
  • 20-30% are synchronous
  • 70-80% are metachronous
  • Median time between tumors of 5 years
  • Long term survival approaches 90%
  • Seminoma is the most common histology
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6
Q

Testicular cancer originates from ____, 90% arise ____, and the precursor lesion is ____

A

Testicular cancer originates from pluripotent germ cell, 90% arise within the testes, and the precursor lesion is intratubular germ cell neoplasia

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7
Q

____ which causes ____ is shown in most testicular GCTs

A

l(12p) which causes duplication of the short arm of chromosome 12 is shown in most testicular GCTs

  • No corewlation with prognosis
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8
Q

Describe signs and symptoms of testicular cancer

A

Signs and symptoms of testicular cancer

  • Mass or swelling
  • Pain (usually mild, NSGCT > seminoma)
  • Hydrocele / hematocele
  • Gynecomastia ± mastodynia
  • Chest pain, dyspnea, cough
  • Abdominal / back pain
  • CNS symptoms
  • Lower extremity swelling
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9
Q

____ is often misdiagnosed as orchitis and/or epididymitis

A

Testicular cancer is often misdiagnosed as orchitis and/or epididymitis

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10
Q

Describe diagnosis of testicular cancer

A

Diagnosis of testicular cancer

  • Self-examination
  • Mass with induration ± pain
  • (-) transillumination
  • Scrotal ultrasound
  • B-hCG
  • AFP
  • LDH
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11
Q

hCG is a product of ____ and elevated in 40-60% of patients with ____ and 15% of patients with ____

A

hCG is a product of syncytiotrophoblasts and elevated in 40-60% of patients with testis cancer and 15% of patients with pure seminoma

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12
Q

___ is NEVER seen in pure seminoma or pure choriocarcinoma

A

AFP is NEVER seen in pure seminoma or pure choriocarcinoma

  • Product of yolk sac elements
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13
Q

___ > 200 U/dl is usually a reliable marker of GCTs and is a particularly useful tumor marker for advanced seminomas

A

LDH > 200 U/dl is usually a reliable marker of GCTs and is a particularly useful tumor marker for advanced seminomas

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14
Q

Describe initial management of a testicular tumor

A

Initial management of a testicular tumor

  • Sperm bank
  • 20-60% of GCT patients have abnormal preop semen analysis
  • Help patients make an informed decision about the pros / cons of inserting a testicular prosthesis
  • Perform a radical (inguinal) orchiectomy: decreases chance of cutting into the tumor and subsequent contamination of scrotal lymphatics, removes in transit disease located within lymphatics of the spermatic cord
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15
Q

Partial orchiectomy is ____

A

Partial orchiectomy is never a good idea

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16
Q

Describe pathology of testicular neoplasms

A

Pathology of testicular neoplasms

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17
Q

This is a ___

A

This is a seminoma

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18
Q

This is a ___

A

This is an embryonal carcinoma

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19
Q

This is a ____

A

This is a yolk sac tumor

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20
Q

Choriocarcinoma is composed of two types of tumor cells: ____ and ____

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A

Choriocarcinoma is composed of two types of tumor cells: syncytiotrophoblasts (b-hCG) and cytotrophoblasts

21
Q

Describe staging testis cancer

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A

Staging testis cancer

  • CXR (clinical stage 1) or seminoma
  • CAT scan of chest (clinical stage 2, 3)
  • CAT scans of abdomen and pelvis
  • Post-orchiectomy tumor markers
  • MRI (great vessels, liver)
  • PET scan (post-chemotherapy seminoma)
22
Q

Testis cancer advanced stage disease may involve ____ or ____

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A

Testis cancer advanced stage disease may involve supraclavicular lymph node metastases or massive retroperitoneal lymph nodes

23
Q

Describe lymphatic drainage of testis

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A

Lymphatic drainage of testis

  • R testis: interaortocaval, pre-caval, pre-aortic
  • L testis: para-aortic, pre-aortic, interaortocaval
  • Inguinal lymph nodes: not commonly involved in absence of tunica / scrotal wall invasion or disruption in normal lymphatic flow
  • Iliac lymph nodes: potentially involved with epididymal / cord invasion, cryptorchidism, previous inguinal injury
24
Q

Describe the AJCC staging system for testicular cancer

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A

AJCC staging system for testicular cancer

  • I: confined to testis
  • IS: confined to testis with post-orchiectomy elevation of serum tumor markers
  • II: retroperitoneal metastases
  • IIA: ≤ 5 nodes, all < 2 cm
  • IIB: > 5 nodes, 2-5 cm
  • IIC: > 5 cm
  • III: supra-diaphragmatic or visceral metastases
25
Stage I seminoma can be managed with \_\_\_\_, \_\_\_\_, and \_\_\_\_
Stage I seminoma can be managed with surveillance, adjuvant XRT (20 Gy to para-aortic), and single-dose carboplatin * Relapse risk high with surveillance * High recurrence-free and and cancer-specific survival with XRT
26
Stage IIA or non-bulky IIb seminoma is managed with \_\_\_\_
Stage IIA or non-bulky IIb seminoma is managed with radiation therapy * 30-36 Gy * Right: interaortocaval, precaval, paracaval, and ipsilateral iliac * Left: para-aortic and ipsilateral iliac
27
Bulky stage IIB or stage III seminoma is managed with \_\_\_\_
Bulky stage IIB or stage III seminoma is managed with chemotherapy
28
Describe initial NSGCT treatment by stagea
Initial NSGCT treatment by stagea * Stage I: surveillance, RPLND or chemo in high-risk patients * Stage IIA and non-bulky IIB: RPLND for solitary node \< 3 cm, chemo for any node \> 3 pm * Bulky IIB and stage III: chemo
29
NSGCT stage 1 can be managed with surveillance if \_\_\_\_
NSGCT stage 1 can be managed with surveillance if normal post-orchiectomy tumor markers
30
Risk factors for recurrence such as ___ drive management decisions for NSGCT
Risk factors for recurrence such as lymphovascular invasion drive management decisions for NSGCT
31
Describe complications of chemotherapy
32
\_\_\_ can be used as a diagnostic and therapeutic procedure for stage I NSGCT
RPLND can be used as a diagnostic and therapeutic procedure for stage I NSGCT
33
Describe ejaculatory neuroanatomy
Ejaculatory neuroanatomy * Non-nerve sparing full templates lead to retrograde ejaculation in 95% * Antegrade ejaculation requires: one sympathetic chain, ≥ 1 post-sympathetic efferent nerve, and hypogastric plexus * Two approaches to optimize antegrade ejaculation: nerve-sparing, modified templates
34
RPLND is associated with ___ survival
RPLND is associated with increased survival
35
Describe patterns of retroperitoneal metastases of NSGCT
Patterns of retroperitoneal metastases of NSGCT * No reliable sentinel node in retroperitoneum * Most metastases occur in NSGCT * Right sided tumors commonly metastasize to the interoaortocaval region and are capable of right to left RP spread * Left sided tumors commonly metastasize to para-aortic with low likelihood to left to right RP spread
36
Cure rate ____ as NSGCT stage increases
Cure rate decreases as NSGCT stage increases
37
\_\_\_\_ can be used after chemotherapy in NSGCT
Surveillance
38
Describe characteristics of late relapse of testis cancer
Late relapse of testis cancer * \> 2 years after initial treatment * AFP is predominant tumor marker but tumor markers normal in 25% * Yolk sac and teratoma are most common histologies * RP and chest are most common site * Chemoresistant * Manage with surgery
39
Patients with GCTs should be encouraged to ___ prior to initiating treatment
Patients with GCTs should be encouraged to sperm bank prior to initiating treatment
40
Leydig and Sertoli cell tumors present with ____ and ____ such as \_\_\_\_, \_\_\_\_, and \_\_\_\_
Leydig and Sertoli cell tumors present with palpable mass and abnormalities in testosterone / estrogen secretion such as virilization, gynecomastia, and loss of libido * Most benign * Surgery is curative but use surveillance of RPLND if clinical stage 1
41
Describe testicular lymphoma
Testicular lymphoma * Generally seen in older patients (60-80) * Most common cause of a testis mass in men \> 60 years old * Typically presents with diffuse enlargement rather than a discrete mass * Infiltrating lymphoma cells between tubules * Majority of cases are diffuse large B cell lymphomas * Age, tubule sparing, no lymphocytes, and cytology differentiate from seminoma
42
\_\_\_ are primarily responsible for the blood-testis barrier
Sertoli cells are primarily responsible for the blood-testis barrier
43
Significant standalone risk factors for germ cell cancer are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Significant standalone risk factors for germ cell cancer are personal / FMHx of GCT, infertility associated with Y chromosome microdeletions, and Klinefelter's syndrome
44
Half life of LDH \_\_\_\_
Half life of LDH can range from 10 hours to 3 days depending on the iso-enzymes expressed by the tumor
45
\_\_\_ is a testicular tumor characterized by lymphocytic tumor
Classic seminoma is a testicular tumor characterized by lymphocytic tumor
46
\_\_\_\_ lymph node group is primarily landing spot for right sided testis tumor
Interaortocaval lymph node group is primarily landing spot for right sided testis tumor
47
\_\_\_\_ is the best treatment option for a patient with mixed GCT of the L testis exhibiting persistently elevated post-orchiectomy tumor markers despite normal CAT scans
PEB chemotherapy is the best treatment option for a patient with mixed GCT of the L testis exhibiting persistently elevated post-orchiectomy tumor markers despite normal CAT scans
48
Injury to ____ may contribute to development of anejaculation following a PC-RPLND
Injury to hypogastric plexus may contribute to development of anejaculation following a PC-RPLND
49
\_\_\_\_ is the most common testicular neoplasm identified in men over age 60
Lymphoma is the most common testicular neoplasm identified in men over age 60

Repro / GU (46 decks)

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