Testicular

Question 1

What percentage of all male cancers does testicular cancer account for?

Answer 1

1%

Question 2

What is the most common age range for testicular cancer?

Answer 2

15-35 years

Question 3

What is the average age of diagnosis for testicular cancer?

Answer 3

33 years

Question 4

In which demographic is testicular cancer more common?

Answer 4

Caucasians

Question 5

What is cryptorchidism?

Answer 5

Undescended testes

90% of patients will not have a history of cryptorchidism.

Question 6

What condition can increase the chance of testicular cancer?

Answer 6

Atrophy of testes

Question 7

What is a common symptom of testicular cancer?

Answer 7

Usually appears as painless swelling or a nodular mass in the scrotum.

Question 8

What sensations might a patient experience in the scrotum or lower abdomen?

Answer 8

Dull ache or heaviness.

Question 9

What percentage of patients experience acute and severe pain?

Answer 9

10% of patients.

Question 10

What previous medical history might be relevant for testicular cancer?

Answer 10

Previous trauma.

Question 11

What is a potential symptom related to gynecomastia in testicular cancer?

Answer 11

Gynecomastia occurs in 5% of patients (germ cell tumors).

Question 12

What type of tumors can produce HCG?

Answer 12

Germ cell tumors such as choriocarcinoma.

Question 13

How is testicular cancer often detected?

Answer 13

Often detected by self palpation.

Question 14

What is the first step in the diagnostic workup for testicular cancer?

Answer 14

H&P

Question 15

What imaging study is used in the diagnostic workup for testicular cancer?

Answer 15

Ultrasound

Question 16

Which tumor markers become elevated in non-seminomas?

Answer 16

AFP (Serum Alpha-fetoprotein) and beta hCG (Human Chorionic Gonadotrophin)

Question 17

What surgical procedure is commonly performed in the treatment of testicular cancer?

Answer 17

Orchiectomy

Question 18

What imaging studies are performed to check for lymph node involvement and distant metastasis?

Answer 18

CT scan of chest, abdomen, and pelvis

Question 19

What should be considered for patients whose treatment may compromise fertility?

Answer 19

A semen analysis and sperm banking should be considered for patients who intend to have children in the future.

Question 20

What is seminoma?

Answer 20

Seminoma is the most common type of testicular cancer and has three subtypes: Classic, Anaplastic, and Spermatocytic.

Question 21

What are the subtypes of seminoma?

Answer 21

The subtypes of seminoma are Classic, Anaplastic, and Spermatocytic.

Question 22

Do the prognoses differ among seminoma subtypes?

Answer 22

No, the prognoses are not significantly different for the various subtypes.

Question 23

What are non-seminoma tumors?

Answer 23

Non-seminoma tumors include Embryonal adenocarcinoma, Teratoma, Choriocarcinoma, and Yolk sac carcinoma (in children).

Question 24

What are the embryonic tissues involved in testicular cancer?

Answer 24

The embryonic tissues involved are ectoderm, endoderm, and mesoderm.

Question 25

What is a teratoma?

Answer 25

A teratoma is a type of tumor that can contain different types of tissues.

Question 26

What is yolk sac carcinoma?

Answer 26

Yolk sac carcinoma is a type of non-seminoma tumor that primarily affects children.

Question 27

What organizations are involved in staging testicular cancers?

Answer 27

The European Organization for Research on Treatment of Cancer (EORTC) and the International Union Against Cancer (UICC) are involved in staging testicular cancers.

Question 28

Which staging systems are used for testicular cancers?

Answer 28

AJCC staging systems are used to stage testicular cancers.

Question 29

What are the anatomical structures related to testicular cancer?

Answer 29

Spermatic Cord, Tunica Vaginalis, Epididymis, Scrotum, and Testis.

Question 30

What does T2, T3, and T4 represent in testicular cancer staging?

Answer 30

T2, T3, and T4 are classifications used in the staging of testicular cancer.

Question 31

What is the tendency of pure seminomas regarding spread?

Answer 31

Pure seminomas have a much greater tendency to remain localized or involve only lymph nodes.

Question 32

How do non-seminomatous germ cell tumors of the testes spread?

Answer 32

Non-seminomatous germ cell tumors may spread via lymphatic or hematogenous routes.

Question 33

What are the routes of lymphatic spread?

Answer 33

Lymphatic spread occurs in an orderly fashion through paraortic, mediastinal, and supraclavicular regions.

Question 34

Where can metastasis rarely occur in testicular cancer?

Answer 34

Metastasis can rarely occur in the lung, bone, liver, and brain.

Question 35

What is the treatment of choice for stage I seminoma?

Answer 35

The most commonly applied treatment is radical orchiectomy and postoperative irradiation of the paradortic or paradortic and ipsilateral pelvic nodes.

Question 36

What setup, for a female patient, is similar to the setup for treating testicular cancer?

Answer 36

Similar to a vulva setup on a female patient.

Question 37

What is the positioning and immobilization for the patient?

Answer 37

Patient is supine, frog legged, with leg vac lok. Arms are high on chest or above head.

Question 38

What is the purpose of the clam shell in testicular cancer simulation?

Answer 38

A scrotal shield is used for the remaining testicle to decrease scattered radiation and preserve fertility.

Question 39

What is the recommended irradiation area for patients with stage I testicular seminoma?

Answer 39

Patients should receive irradiation to the paraaortic or paraaortic and ipsilateral pelvic lymph nodes.

Question 40

What is the superior border of the 'Hockey Stick' field?

Answer 40

The superior border is approximately 110-111 to ensure treatment of the nodes at the level of the renal hilum.

Question 41

What is the inferior border of the 'Hockey Stick' field?

Answer 41

The inferior border is at the bottom of L5 or the top of the acetabulum, depending on whether pelvic nodes are treated.

Question 42

What are the lateral borders of the 'Hockey Stick' field?

Answer 42

The top lateral border is approximately 10cm wide to include the entire vertebrae, and the bottom is at the edge of the ilium.

Question 43

What is the significance of Fig. 7.10?

Answer 43

Fig. 7.10 illustrates the testicular treatment field.

Question 44

What is the T10 reference in radiation borders?

Answer 44

T10 refers to a specific vertebral level used in determining radiation borders.

Question 45

What is the importance of surgical scars in radiation treatment?

Answer 45

Surgical scars can influence the planning and execution of radiation treatment fields.

Question 46

What are the two types of fields used in treating the peridortic and ipsilateral inguinal areas?

Answer 46

A hockey stick shaped portal or two abutting periaortic and iliac fields.

Question 47

What is the advantage of using a single hockey stick portal?

Answer 47

It allows for ease of setup and avoids potential overlap or underdosage that exists when treating two separate ports.

Question 48

What is used to shape the hockey stick field and protect critical organs?

Answer 48

Custom blocks.

Question 49

What is the dose for Seminoma?

Answer 49

6-18 MV photons

Question 50

What areas receive irradiation following surgery for Seminoma?

Answer 50

The periaortic and ipsilateral inguinal iliac areas

Question 51

What is the tumor dose for irradiation in Seminoma?

Answer 51

25 Gy in 15-17 fractions

Question 52

What is the total dose for Paradortic Fields in Seminoma treatment?

Answer 52

2000 cGy

Question 53

What is the total dose for Hockey Stick Field in Seminoma treatment?

Answer 53

2000-2550 cGy

Question 54

What alternative method may be used in Seminoma treatment?

Answer 54

Electrons to treat one of the testicles or the scar from Orchiectomy

Question 55

What is the total boost dose to lymph nodes in Seminoma treatment?

Answer 55

3000-3600 cGy

Question 56

What is the initial treatment for non-seminoma?

Answer 56

Radical Orchiectomy followed by Cisplatin based chemotherapy.

Question 57

What are some chemotherapy regimens for non-seminoma?

Answer 57

Different chemotherapy regimens include: 1. Cisplatin, Vinblastine, Bleomycin (PVB) 2. Bleomycin, VP-16, Cisplatin (BEP) 3. Etoposide, Cisplatin, Bleomycin 4. Etoposide, Ifosamide.

Question 58

What organization provides guidelines for non-seminoma treatment?

Answer 58

National Comprehensive Cancer Network (NCCN).

Question 59

What is the role of radiation in disseminated non-seminoma?

Answer 59

Radiation has little role in the management of patients with disseminated non-seminoma, except in the palliation of brain and other metastatic sites.

Question 60

What is the main treatment in advanced state of testicular cancer?

Answer 60

Chemotherapy is the main treatment in advanced state.

Question 61

What are common side effects of radiation?

Answer 61

Nausea, fatigue, diarrhea ## Footnote Common ailments from radiation near the intestines.

Question 62

What skin reactions can occur from radiation?

Answer 62

Skin reactions occur only in the treatment area with skin folds.

Question 63

How does radiation affect fertility?

Answer 63

Decreased fertility and decrease in sperm count. ## Footnote Spermatogenesis may be affected by doses as low as 50 CGy.

Question 64

What dose of radiation can cause permanent sterility in males?

Answer 64

Permanent sterility occurs at 15-20 Gy to the scrotum.

Question 65

What percentage of the prescription dose does the uninvolved testicle receive?

Answer 65

Typically, the uninvolved testicle receives 1% to 2% of the prescription dose due to scattered radiation through body tissues.

Question 66

How is paraaortic and pelvic radiation generally tolerated?

Answer 66

In general, paraaortic and pelvic radiation is well tolerated.