Tanya (Cervical and testicular cancer)

Question 1

What is testicular cancer?

Answer 1

Cancer affecting male reproductive organ. Affects the testicles which are responsible for sperm production and testosterone. They are made out of many different cells which can become cancerous. The type of cell that becomes cancerous determines the type of cancer. Testicular cancer has a good prognosis.

Question 2

Epidemiology of testicular cancer

Answer 2

Rare, affects 1 in 190 males. Accounts for 1% of all cancer cases in men. It is the 16th most common cancer in males. 5 year survival rate is 97%.

Question 3

Aetiology of testicular cancer

Answer 3

• Family history (if father as it- son is 4x more likely to get it, if brother has it- brother is 9x more likely to get it)
  -Cryptorchidism (undescended testicles)
• Previous testicular cancer
• Testicular carcinoma in situ (Pre-cancer state)
• Ethnic background (more common in Caucasians than Asian or African people)
• HIV

Question 4

Types of testicular cancer

Answer 4

• Non-germ cell tumour
• Germ cell tumour
  
  • Seminoma (B-HCG)
    
    • classical
    • spermatical
      -Mixed (AFP and B-HCG)
  • Non-seminoma
    
    • teratoma
    • teratocarcinoma
    • choriocarcinoma
    • embryonal carcinoma (AFP and B-HCG)
    • yolk sac tumour (AFP)

Question 5

Which type of testicular cancer makes up the majority?

Answer 5

Germ cell tumour- makes up 90% of testicular cancer

Question 6

What age do non-seminoma tumours occur?

Answer 6

Usually between teens and 30s

Question 7

Which sub-type of testicular cancer is most common in children?

Answer 7

Yolk sac tumour

Question 8

What are the signs and symptoms of testicular cancer?

Answer 8

• Testicular limp that is usually painless
• Lumber back pain
• Cough and dyspnoea, difficulty swallowing (related to metastasis)
• CNS symptoms

Question 9

What is used to make a diagnosis of testicular cancer?

Answer 9

• Ultrasound- to visualise abnormal growths
• MRI scan
• Chest X-ray
• Blood test- AFP, LDH, B-HCG

Question 10

What are the stages of testicular cancer?

Answer 10

Stage 1- tumour confined to testes
Stage 2- tumour spread to abdominal lymph nodes
Stage 3- Tumour spread to lumph nodes above the diaphragm
Stage 4- Tumour invading other organs such as liver or lungs

Question 11

What is it called when a tumour invades other organs?

Answer 11

Metastasis

Question 12

What are the treatments for testicular cancer?

Answer 12

• Surgery
• Radiotherapy
• Chemotherapy

Question 13

What is the treatment of stage 1 testicular cancer?

Answer 13

Observation, radiation, chemotherapy (given 4 weekly basis)

Question 14

What is the treatment of stage 2 testicular cancer?

Answer 14

Stage 2a (seminoma) with tumour size <2cm
- radiotherapy
- chemotherapy

Stage 2b (seminoma) with tumour size <5cm
- chemotherapy- cisplatin based regimen

Stages above 2b
- chemotherapy

Question 15

Why is a combination of treatments used? (testicular cancer)

Answer 15

To reduce toxicity and reduce resistance

Question 16

Why would one treatment be chosen over another? (testicular cancer)

Answer 16

They are chosen based on side effects e.g. bleomycin affects the lungs so this would be avoided in athletes

Question 17

Chemotherapy combination regimes (testicular cancer)

Answer 17

BEP
- Bleomycin
- Etoposide
- Cisplatin
EP
- Etoposide
- Cisplatin
VIP
- Etoposide
- Ifosfamide
- Cisplatin

Question 18

What is the indication, route of administration and side effects of Bleomycin? (testicular cancer)

Answer 18

I- metastatic testicular cancer, Non-Hodgkin’s lymphoma
RoA- intramuscularly
SE- fever, malaise, interstitial pneumonia, nausea and vomiting, pulmonary fibrosis

Question 19

What is the indication, route of administration and side effects of Etoposide? (testicular cancer)

Answer 19

I- carcinoma of the bronchus, testicular cancer, lymphoma
RoA- Iv infusion
SE- hypertension, nausea and vomiting, abdominal pain, diarrhoea, fatigue, alopecia, anaemia, leucopenia (reduced WBCs), thrombocytopenia (platelet deficiency)

Question 20

What is the indication, route of administration and side effects of Cisplatin? (testicular cancer)

Answer 20

I- testicular cancer, lung cancer, cervical cancer, bladder cancer, head and neck cancer, ovarian cancer
RoA- IV infusion
SE- severe nausea and vomiting, myelosuppression (decrease in bone marrow activity), nephrotoxic (deterioration in kidney function), hearing loss, peripheral neuropathy, hyperurcaemia (high levels of uric acid in blood), anaphylactic reactions

Question 21

What is the indication, route of administration and side effects of Ifosfamide? (testicular cancer)

Answer 21

I- testicular cancer
RoA- IV infusion
SE- nephrotoxic, neurotoxic and can cause encephalopathy (brain function is affected), nausea and vomiting, hypersensitivity, haemorrhage cystitis

Question 22

What is cervical cancer?

Answer 22

Cancer that starts in the neck of the womb (the cervix)

Question 23

Epidemiology of cervical cancer

Answer 23

Accounts for 2% of all cancers. 13th most common cancer amongst women in the UK. 1 in 139 women will be diagnosed with cervical cancer. 5 year survival rate is 67%

Question 24

Aetiology of cervical cancer

Answer 24

• HPV (Human Papilloma Virus)
• Unprotected sex
• Chemicals
• Age (more common in younger women (under 45))
• Cigarette smoke
• Social deprivation
• Multiparity (producing more than 1 at birth)
• Early onset of sexual intercourse (before age 17)

Question 25

Pathology of cervical cancer

Answer 25

Early changes in the cells of the cervix will first be discovered through a smear test. If there is moderate to severe changes the patient will be invited for colposcopy which allows for the grading of abnormal cells and gives an impression of how deeply abnormal cells have gone into skin of the cervix. These changes are classed according to cervical intraepithelial neoplasia (CIN) changes.

Question 26

What are the stages of cervical cancer?

Answer 26

Stage 0- carcinoma in situ Stage 1A- microscopic disease found only in the cervix Stage 1B- visible disease found only in the cervix Stage 2A- tumour extends beyond cervix without parametrium involvement (parametrium- separates supravaginal portion of cervix from bladder) Stage 2B- parametrium involvement Stage 3A- tumour extends to the pelvic side wall Stage 3B- tumour extends to the pelvic wall with non-functioning kidney Stage 4a- tumour extends to adjacent organs Stage 4B- tumour extends to distant organs (metastasis

Question 27

What are the types of cervical cancer?

Answer 27

Squamous cell Adenocarcinoma Adeno squamous carcinoma Small cell cancer

Question 28

What are the signs and symptoms of cervical cancer?

Answer 28

- Unusual bleeding - Smelling vaginal discharge - Post coital bleeding - Backache (advanced disease) - Blood in urine - Bone pain - Weight loss - Loss of appetite - CIN changes have no symptoms

Question 29

What is the the cervical screening program?

Answer 29

It is used to detect abnormal cell growth in the cervix. Involved a smear test (aka liquid based cytology). Women between the ages of 25-49 yrs old are invited every 3 years and women between the ages of 50-64 are invited every 5 years (unless they have an abnormal screen in which case they will be invited back until screen is normal). In younger women changes occur all the time so they are not offered screening to prevent unnecessary treatment.

Question 30

What is the outpatient diagnosis for cervical cancer?

Answer 30

GP refer patient to gynaecologist Gynaecologist repeat initial examination (smear taken) Colposcopy done prior to admission Patient admitted to hospital for examination and cervical biopsy Histological diagnosis Staging investigations (FBC, chest x-ray, CT or MRI)

Question 31

What are the treatment options for cervical cancer?

Answer 31

The treatment depends on the stage of the disease: Radiotherapy Chemotherapy Chemoradiotherapy Surgery - cone biopsy - radical trachelectomy (removal of cervix) - hysterectomy (removal of cervix and womb)

Question 32

What is the treatment for each stage of cervical cancer?

Answer 32

Stage 0- cone biopsy, surgical excision Stage 1A- hysterectomy, cone biopsy, local excision, radial hysterectomy Stage 1B and 2A- radical hysterectomy, pelvic lymphadenectomy, pelvic irradiation Stage 2B and 3- pelvic radiotherapy Stage 4- chemotherapy (more than 1 chemotherapy ages is used for a synergistic effect)

Question 33

What is the indication, route of administration and side effects of paclitaxel? (cervical cancer)

Answer 33

I- breast and cervical cancer RoA- IV infusion SE- bone marrow suppression, neurotoxicity, hypersensitivity (requires monitoring after infusion), extravasation (leaking of drug into surrounding tissue which can cause tissue damage e.g. tissue necrosis (tissue death))

Question 34

What is the indication, route of administration and side effects of cisplatin/carboplatin? (cervical cancer)

Answer 34

I- testicular cancer, lung cancer, cervical cancer, bladder cancer, head and neck cancer, ovarian cancer RoA- IV infusion SE- severe nausea and vomiting, myelosuppression (decrease in bone marrow activity), nephrotoxic (deterioration in kidney function), hearing loss, peripheral neuropathy, hyperurcaemia, anaphylactic reactions

Question 35

What does the patient need to have before treatment of platinum compounds to decrease nephrotoxic side effect?

Answer 35

Needs IV hydration. Magnesium levels can be affected so these need to be monitored too.

Question 36

What is the indication, route of administration and side effects of topotecan? (cervical cancer)

Answer 36

I- cervical cancer, small cell lung cancer, metastatic ovarian cancer RoA- IV infusion, oral capsules SE- diarrhoea, bone marrow suppression, hypersensitivity, sepsis (WBC con drops so increased infection- neutropenic sepsis), alopecia, mucositis (inflammation in the mouth)

Question 37

What is the indication, route of administration and side effects of bevacizumab? (monoclonal antibody treatment) (cervical cancer)

Answer 37

I- cervical cancer, metastatic breast cancer, metastatic colorectal cancer, metastatic renal cancer, ovarian cancer RoA- IV infusion SE- osteonecrosis of the jaw (needs dental before treatment), fatigue, pain, lack of energy, GI effects Monitoring- blood pressure as can cause hypertension