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EMPIRE In-Service Review > Testicular Cancer > Flashcards

Testicular Cancer Flashcards

(56 cards)

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1
Q

Most common presentation of testes ca.

A

localized seminoma

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2
Q

Most common age range at presentation

A

20-35 y.o.

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3
Q

Risk factors for testes cancer

A

Cryptorchidism
Family or personal hx of testes cancer
Intra-tubular germ cell neoplasia

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4
Q

Must perform orchiopexy before ____ to decrease testicular cancer rates

A

puberty

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5
Q

Seminomas often have ____ that produce bHCG

A

synctiotrophoblasts

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6
Q

Choriocarcinoma

VERY HIGH ____

Spreads via ____

Hemorrhagic ____ mets

A

v high bHCG

Hematogenous spread

hemorrhagic brain mets

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7
Q

____ tumors are chemo/rads resistant

A

Teratoma

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8
Q

____ tumors are most commonly in pre-pubertal children

A

Yolk Sac

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9
Q

Imaging study for testicular mass

A

scrotal u/s

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10
Q

Tumor markers should be followed up ____ s/p orchiectomy

A

4-5 weeks

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11
Q

Staging imaging

A

CT abd/pelvis

CXR (low risk) vs CT chest

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12
Q

Tumor confined to testes + epididymis w/o LVI

p___

A

pT1

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13
Q

Tumor confined to testes + epididymis w LVI OR tunica vaginalis invasion

p___

A

pT2

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14
Q

Tumor invading spermatic cord

p___

A

pT3

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15
Q

Tumor invading scrotum

p___

A

pT4

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16
Q

Nodal disease
only applies to RP nodes

N1 - ___ cm

A

N1 - <2cm
N2 - 2-5 cm
N3 - >5 cm

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17
Q

Seminoma with <3cm Tumor confined to testes + epididymis w/o LVI

p___

A

T1a

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18
Q

Seminoma with >3cm Tumor confined to testes + epididymis w/o LVI

p___

A

T1b

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19
Q

Seminoma confined to testes is always clinical stage ____

A

T1

T1a - pT1
T1b - pT2-4

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20
Q

Seminoma with RP nodal mets & S0-1 is clinical stage ___

A

T2

T2a - cN1
T2b - cN2
T2c - cN3

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21
Q

Seminoma with distant mets is clinical stage ___

A

T3

T3a - S1
T3b - S2
T3c - S3

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22
Q

Half life of AFP

A

5-7 days

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23
Q

AFP is NEVER elevated in ____

24
Q

Half life of bHCG

25
Half life of LDH
24 hrs
26
Yolk sac has elevated ___ tumor marker
AFP
27
Seminoma - localized or with pulmonary mets ____ risk disease
Good
28
Seminoma with non-pulmonary mets ____ risk disease
Intermediate
29
Non-seminoma with S1 tumor markers ____ risk disease
Good
30
Non-seminoma with S2 tumor markers ____ risk disease
Intermediate
31
Non-seminoma with S3 tumor markers OR mediastinal primary OR non-pulmonary mets ____ risk disease
Poor
32
Right testes tumors spread to ____ LNs
inter-aortocaval
33
Left testes tumors spread to ____ LNs
Para-aortic
34
ITCGN ___% develop testes cancer
50
35
ITCGN Treatment
Surveillance Orchiectomy (100% cure) XRT (100% cure) Chemo (66% cure)
36
Relapse rates for seminoma Surveillance only - ___% 1 round of Carboplatin - ___%
Surveil - 14% Chemo - 4%
37
Median time to relapse for seminoma s/p orchiectomy
1.5 years
38
Strongest risk factors for non-seminoma relapse
LVI | Embryonal tumors
39
Relapse rates for seminoma (without risk factors) Surveillance only - ___% BEP x1 - ___%
15% 1%
40
Relapse rates for seminoma (with risk factors) Surveillance only - ___% BEP x1 - ___%
40% 3%
41
Treatment if node + at time of primary RPLND N1 - ____ N2 - ____ N3 - ____
N1 - surveillance N2 - EPx2 or BEPx2 N3 - BEPx3 or EPx4
42
To preserve antegrade ejaculation after RPLND, spare ___ nerves
L1-L3 post-ganglionic sympathetic nerves **behind the IVC**
43
Bleomycin adverse effects
pulmonary toxicity
44
Which stages of non-seminoma do you offer primary RPLND?
Stage IIA/B * do not perform with elevated tumor markers* * potential reduces chemo burden*
45
Which stages of seminoma can you offer RT?
Stage IIA/B - nodal positive disease, 2-5 cm
46
Must wait at least ____ s/p chemo to perform PET CT
6 weeks
47
Seminoma s/p chemo Next step if no mass or <3cm mass - ____
Surveillance
48
Seminoma s/p chemo Next step if >3cm mass - ____
PET CT - Negative - surveillance - Positive - resection
49
Seminoma s/p chemo Next step if tumor growth or tumor marker elevation - ____
2nd line chemo | TIP/VeIP
50
Non-seminoma s/p chemo Next step if no mass or <1cm mass with normal tumor markers - ____
Surveillance or RPLND
51
Non-seminoma s/p chemo Next step if >1cm mass with normal tumor markers - ____
post-chemo RPLND
52
Non-seminoma s/p chemo Next step if persistent elevated tumor markers - ____
2nd line chemo | TIP/VeIP
53
Long term risks of chemo for testes ca patients
Cardiovascular disease 2ndary cancers
54
Management of post-chemo distant mets
resect if possible
55
Offer all patient ____ prior to treatment to maintain fertility
sperm banking
56
Treatment after trans-scrotal orchiectomy
Observe vs excise scar vs RT

EMPIRE In-Service Review (6 decks)

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