Flashcards in 05a: Testicular/Prostate Deck (35)
Cancers in the scrotum can arise from various tissues. List the different categories of tumors.
1. Germ cell tumors (seminoma, nonseminoma)
2. Sex cord-stromal
T/F: Testicular cancer is the most common cancer in the young adult/middle aged man.
True (20-34 yo) - but still a very rare cancer
T/F: Testicular cancer cannot occur before puberty
T/F: Testicular cancer is highly treatable with quite simple Rx.
False - highly curable, but complex Rx, need multi-disciplinary team
List some RFs for testicular cancer:
1. Past Hx of testicular cancer
3. Kleinfelter's or Down's
5. Heavy marijuana use
T/F: Testicular cancer most common in white males.
Most common initial presentation/Sx for testicular cancer:
Painless scrotal mass
List some Sx of advanced testicular cancer that patients may present with:
1. Back pain (enlarged nodes)
2. Gynecomastia (high hCG)
4. Sx of metastasis (bone pain, kidney failure, neuro/liver issues, etc.)
List the lab markers checked for suspected testicular germ cell tumors
3. Beta HCG
If testicular cancer is suspected based on lab work, what's the next step?
Urgent scrotal ultrasound
Testicular cancers spread in (orderly/disorderly) pattern.
Orderly - 95% start in retroperitoneum
Testicular cancer imaging: urgent (X) used to assess scrotal mass. Which other imaging modalities would you order?
X = scrotal ultrasound
Abdominal/pelvic CT with contrast (assess retroperitoneum for cancer spread)
Patient with suspicious L testicular mass gets abdominal CT to assess for metastasis. Where is the first place you'd expect to find the mass if this was cancer?
L Para-aortic space (between aorta and kidney) - since L testicular vein drains into L renal artery
Patient with suspicious R testicular mass gets abdominal CT to assess for metastasis. Where is the first place you'd expect to find the mass if this was cancer?
Inter-aortocaval space (under renal vein) - since R testicular vein drains into IVC directly
Testicular cancer: what's the step after cancer is confirmed by imaging?
Urgent urology consult
T/F: After imaging, testicular cancer is definitively diagnosed by biopsy.
False! NO scrotal biopsy done and inguinal approach for biopsy is rarely performed
Testicular cancer: (X) procedure is both diagnostic and therapeutic for these patients.
X = orchiectomy (radical removal of entire testicle via inguinal excision)
Seminoma: which lab markers are elevated? Star the one that rises to greatest extent.
(don't make AFP)
Non-seminoma: which lab markers are elevated? Star the one that rises to greatest extent.
Can be any combo, with varying amounts (depending on specific type of carcinoma)
Embryonal carcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
HCG (histo looks like that of embryo)
Yolk sac carcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
AFP (histo looks like that of yolk sac)
Choriocarcinoma is a (seminoma/nonseminoma) and mainly makes which lab marker?
HCG (histo looks like that of placenta)
T/F: Teratoma is a seminoma and responds best to chemo/radiation dual therapy.
False - it's a non-seminoma that does NOT respond to chemo/radiation (requires surgical resection)
(X) non-seminoma raises LDH, but not HCG or AFP.
X = teratoma
Testicular cancer: what does stage 1S mean?
Imaging normal, but tumor markers elevated after orchiectomy
The worst category of stratification for testicular cancer is (seminoma/non-seminoma) in Stage (X) and (Y) risk stratification group. What's the cure rate?
X = III
Y = poor risk
T/F: In general, loss of one testicle does not negatively impact fertility
True - may actually improve function of contralateral testicle
Retroperitoneal Lymph Node Dissection (RPLND) is a procedure only done in (X) testicular cancer patients. There is (rare) risk of which complication?
X = non-seminoma
Testicular cancer: which tumors get radiation?
Only seminomas (exquisitely sensitive to radiation)