UROLOGY Flashcards Preview

A ORAL BOARDS 2016 > UROLOGY > Flashcards

Flashcards in UROLOGY Deck (18):
1

prostate cancer tests

alkaline
phosphatase,
prostatic specific antigen,
bone scan.

2

Markers that maybe positive in seminoma

LDH - high-level infers advanced disease

Only 25% positive Beta hCG
"semen causes pregnancy some of the time"

NO AFP
"semen is not for babies"

3

Markers that maybe positive and non-seminal germ cell tumor

Beta hCG
AFP
LDH - suggest more advanced disease

4

Adjuvant therapy for seminoma

Very sensitive to XRT

possible use of chemo

5

What is chemotherapy for non-seminomatous germ cell tumors

Bleomycin
"Lance Armstrong"

Cis-platinum
"Testicles are platinum cysts"

6

germ cell tumors list

Most common:
Leydig
Sertoli cell

7

other malignant lesions besides a germ cell tumors

lymphoma
metastatic lesions
Mumps
Infection
Lymphoma

8

Nonseminomatous tumor types include

embryonal carcinoma,

yolk sac tumor (presenting in infants and children),

choriocarcinoma,

teratoma;

9

–germ cell tumors risk of malignancy

usually nonmalignant;

less than 10% of Leydig or Sertoli cell tumors are considered malignant.

10

Risk factors for the development of germ cell tumors

greatest with the intra-abdominal undescended testis

cryptorchidism.


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.

11

Work up of scrotal mass

Any scrotal mass lesion that cannot be definitively determined to be benign on physical examination should undergo scrotal

ultrasound.

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.

12

Constitutional symptoms that may be present with metastatic testicular cancer



back pain,

pulmonary symptoms,

weight loss,

abdominal mass.

Neuro

13

Metastatic disease from testicular cancer

predictable retroperitoneal lymphatic path

right testis, initial To:
periCAVAL
and
interaortocaval

left, to
left para-AORTA nodes,

and then on to other retroperitoneal nodal levels on either side.

Distant metastases:
lung,
liver,
brain,
bone,
kidney,
adrenal

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)

14

Testis tumor patients should be worked up how

scotal US
tumor markers
CT chest, abd, pelv

pos:
bone scan
Head

AND

Testis tumor patients should undergo COPMPLETE metastatic evaluation
(becuase 20-40% present metastatic)

tumor markers:
(β-human chorionic gonadotropin [hCG] (pos 25% sem)

alpha-fetoprotein [AFP] (NEVER pos for sem - "not for babies")

Lactate dehydrogenase [LDH])

CT:
chest, abdomen, and pelvis, preferably prior to orchiectomy to avoid postsurgical artifacts.

based on suspicion (or ALL choriocarcinomas):

Bone and/or brain imaging

15

The standard initial treatment for testicular tumors is

radical inguinal orchiectomy

groin incision

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


16

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

17

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.

18

varicocele tx

support first choice:
NSAID
and support

surgical treatment:
ligating the gonadal vein so that retrograde blood flow can no longer reach the plexus of veins in the scrotum.

Approaches include inguinal, subinguinal, lumbar, and laparoscopic. Some urologists favor a microsurgical approach, citing a lower recurrence rate.