Germ cell tumors Flashcards Preview

SADL Oncology > Germ cell tumors > Flashcards

Flashcards in Germ cell tumors Deck (13):
1

Syndromes with risk of GCT

Kleinfelter (XXY)
Gonadal dysgenesis - swyer, turner
Cryptorchidism
GU anomalies

2

GCT Histology

Tertatomo (benign)

Germinoma (dysgerminoma, seminoma)

Non-germinomatous GCT
- Embryonal carcinoma
- YST
- choriocarcinoma
- malignant mixed GCT

3

Presentation of GCT by age and histology

girls: ovarian > age 3

Boys: testicular <4 or >13

Extra-gonadal 80% stage 3/4
- sacrococcygeal <4
- mediastinum >9
- brain > 1

4

Key Differentials:

1) young child with precocious puberty

2) Amenorrhea or virilization

Sex cord stromal tumors

1) Granulosa tumor

2) Sertoli-Leydig tumor

*** usually associated with Dicer1

5

AFP
- half life
- normal for term and prem
- normal for adult

BHCG
- half life

AFP
- half-life 5-7d
- newborn >40K; prem >100K
- adult < 10 (reached by 12m)

BHCG
- half-life 24-36h
- normal < 5

6

Cytogenetic changes

prepubertal: 6q and 1p del

adol/adult: i12p, 13- and +21

extragonadal: X+

7

Preop Workup

CBC
Liver and renal function
AFP, BHCG
CT/MRI of primary
CT chest/abdo/pelvis for distant mets
+/- bone scan

8

Key points re: testicular tumors

Inguinal incision
- typically do radical orchiectomy (unless teratoma)

- LN biopsy if 2-4 cm. If > 4cm Stage 3 automatically

- if scrotal approach, go back and resect proximal structures.

Hemiscrotectomy not needed

9

Sacrococcygeal GCT

- most common GCT

- 2 patterns: baby with large exophytic lesion (rarely malignant) or older infant with internal lesion (more likely to be malignant)

- Stage 1 gets surgery only. Stage 2-4 get surgery + chemo
--> must remove coccyx

- Prog factors: age, histology, resection

10

High risk features

Age > 11
Tumor site (mediastinum worst)
Stage

11

Key points re: ovarian tumors

- 10-20% are malignant
- peritoneal cytology
- unilateral oophorectomy and biopsy suspicious lesions on other ovary
- consider upfront chemo and fertility sparing surgery for bilateral tumors

12

GCT risk groups

Low: Stage 1 immature teratoma or testicular - surgery only. OS>95%

IR: Stage 2-4 gonadal, Stage 1-2 extragonadal - surgery + chemo. OS >90%

HR: Stage 3-4 extragonadal. Surgery + chemo. OS 70%

13

Standard chemo approaches

PEB: Cisplat/Etop/Bleo
- adolescents should get weekly bleo

AGCT1531 - testing Carbop (JEB) instead of Cisplat (PEB)

Germans use Etop/Ifos/Cisp (VIP)
-- consider this for mediastinal primary. Less post-op issues w/o Bleo

Stage 1/2: 4 cycles post resection
Stage 3/4: 4 cycles then surgery