Flashcards in Testicular Deck (13):
1
What are some risk factors for testicular cancer?
Cryptorchism (higher risk for abdominal then ingiunal)
Age 15-40
HIV
Klinefelters
Down syndrome
Caucasian
Family history
2
Clinical,features of testicular cancer?
Firm rubbery lump, some present with acutely painful testicle
Symptoms from metastatic disease - back pain, sob, CNS
Paraneoplastic limbic encephalitis
Gynaecomastiamifmhigh production of BHCG
Abdominal ache
3
Diagnosis of testicular cancer?
Ultrasound
CT abdo/ pelvis (chest if symptoms or CXR abnormal)
Tumour markers (LDH, B hCG, AFP)
CNS imaging if symptoms
Removal of testis for histology
4
What are the differences between NSGCT (nonseminoma) and seminoma?
NSGCT
- contain either embryonal, choriocarcinoma, yolk sac tumour, teratoma or a mixture
- if AFP is high can only be NSGCT (produced by yolk sac cells)
- tend to be more aggressive, present at a more advanced stage
Seminoma
- most present with localised disease
- indolent
- BHCG and LDH can be raised but not AFP
- consist of only pure seminoma (if any other component = NSGCT)
- metastases less through blood to distant sites then NSGCT
5
What are the risk stratification for advanced seminoma?
Good risk
Intermediate risk - have metastasis outside of lung and lymph nodes
6
What is the risk stratification for advanced non-seminoma?
Good risk - pulmonary or nodal risk with low tumour markers
Intermediate risk
Poor risk - metastases other then lung and nodes + higher tumor markers
7
What is the staging for Testicular germ cell tumors?
Stage 1 - localised to testis
Stage 2 - localised to lymph nodes
Stage 3 - metastatic disease
8
What subtypes make up testicular cancer?
Germ cell tumours = seminoma and nonseminoma
Sex cord stromal tumors (Leidig, Sertoli cell)
Lymphoma and metastatic disease from other primaries
9
What is the treatment of seminoma following orchiectomy?
Stage 1 - surveillance is preferred, however if high risk features (rete testis invasion + large tumour greater then 4cm) can consider single dose carboplatin
Advanced disease - 3-4 cycles of BEP chemotherapy (Bleomycin/etoposide/cisplatin) followed by resection of residual disease
10
What is the treatment of non-seminoma following orchiectomy?
Stage 1 - surveillance vs retroperiotneal lymph node dissection vs 1-2 cycles BEP (later 2 options for higher risk disease
Advanced - 3-4 cycles BEP chemotherapy
Resection of residual masses
11
What is the prognosis of testicular cancer?
Good risk TGCT - 5 year OS 92%
Poor risk NSGCT - 5 year OS 48%
12
What is the feared side effect of bleomycin?
Lung toxicity - pulmonary fibrosis with oxygen toxicity (worsening of fibrosis with high flow oxygen administration)
Need regular Lung function tests
13