Flashcards in UROLOGY Deck (18):
prostate cancer tests
prostatic specific antigen,
Markers that maybe positive in seminoma
LDH - high-level infers advanced disease
Only 25% positive Beta hCG
"semen causes pregnancy some of the time"
"semen is not for babies"
Markers that maybe positive and non-seminal germ cell tumor
LDH - suggest more advanced disease
Adjuvant therapy for seminoma
Very sensitive to XRT
possible use of chemo
What is chemotherapy for non-seminomatous germ cell tumors
"Testicles are platinum cysts"
germ cell tumors list
other malignant lesions besides a germ cell tumors
Nonseminomatous tumor types include
yolk sac tumor (presenting in infants and children),
–germ cell tumors risk of malignancy
less than 10% of Leydig or Sertoli cell tumors are considered malignant.
Risk factors for the development of germ cell tumors
greatest with the intra-abdominal undescended testis
lower risk, but still elevated, in testes located in a groin position.
Various intersex abnormalities are also risk factors for germ cell tumor.
HIV infection is thought to be a risk factor for testicular cancer.
It is controversial whether testicular atrophy of a benign cause elevates germ cell tumor risk.
Work up of scrotal mass
Any scrotal mass lesion that cannot be definitively determined to be benign on physical examination should undergo scrotal
Patients who have a hydrocele or other cystic lesion of the scrotal contents should also undergo ultrasound if the testis cannot be definitively palpated and determined to be entirely normal.
Constitutional symptoms that may be present with metastatic testicular cancer
Metastatic disease from testicular cancer
predictable retroperitoneal lymphatic path
right testis, initial To:
left para-AORTA nodes,
and then on to other retroperitoneal nodal levels on either side.
The likelihood of a man’s presenting with metastatic disease is approximately 20% for seminoma and higher (30% to 60%) with nonseminomatous tumors
(choriocarcinoma is notorious for hematogenous spread early to distant sites AND NEED BRAIN MRI)
Testis tumor patients should be worked up how
CT chest, abd, pelv
Testis tumor patients should undergo COPMPLETE metastatic evaluation
(becuase 20-40% present metastatic)
(β-human chorionic gonadotropin [hCG] (pos 25% sem)
alpha-fetoprotein [AFP] (NEVER pos for sem - "not for babies")
Lactate dehydrogenase [LDH])
chest, abdomen, and pelvis, preferably prior to orchiectomy to avoid postsurgical artifacts.
based on suspicion (or ALL choriocarcinomas):
Bone and/or brain imaging
The standard initial treatment for testicular tumors is
radical inguinal orchiectomy
with mobilization of the spermatic cord from within the inguinal canal
mobilization of the testis from the scrotum
keep intact parietal tunica vaginalis sac. It
(enter the tunica vaginalis inadvertently can spill tumor)
Ligate spermatic cord high at the level of the internal inguinal ring;
marking suture should be left
Management of advanced disease
Following orchiectomy depending on stage:
retroperitoneal radiation therapy - seminoma most sensitive - 25 to 30 Gy; more advanced IIC/ III give them
Cis-platinum and bleo + etoposide
retroperitoneal lymphadenectomy (RPLND - even with stage I non-sem for staging) - yes still going for cure
systemic chemotherapy - more for non-sem
Overall, long-term survival for testicular cancer
Overall, long-term survival for testicular cancer ranges from 98% to 99% for both stage I seminoma and nonseminoma
40% to 80% for both stage II and III seminoma and nonseminoma.