Testicular Cancers – Flashcards
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What are the 3 functions of testosterone?
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1. develop the body 2 become masculine 2. promote & maintain development of male organs 3. Promotes muscular development
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What are the 2 main functions of the testes?
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1. secrete testosterone 2. lodges the sperm in the different stages
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Where are the testes contained in & what are the syspended by?
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contained in the scrotum & suspended by the spermatic cords
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Which spermatic cord is longer?
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the left cord is usually longer than the right
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Testicular cancer is most common between what ages?
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20-34
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True or False: Testicular cancer can affect 50-55 year old males, but prognosis is better as you get older.
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false. testicular cancer can affect men 50-55, but prognosis is usually WORSE as you get older :(
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The greatest incidence of testicular cancer is in _____, US, and ___.
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The greatest incidence of testicular cancer is in Denmark, US, and UK.
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What cell type is most common?
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Germ cell tumors
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Testicular cancer incidence is lowest in ____, Africa, North American Blacks, and _______.
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Testicular cancer incidence is lowest in Asia, Africa, North American Blacks, and Puerto Rico.
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True or False: Testicular cancer is relatively rare.
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true
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What are the 4 etiologies associated with testicular cancer?
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1. Gonadal Dysgenesis 2. Cryptorchidism 3. Family History of Testicular Cancer 4. Previously Diagnosed in Opposite Testicle
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What is gonadal dysgenesis?
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testicles have not descended normally
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What is "cryptorchidism?"
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Abdominal, undecended testicles
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What familial factors increase a males risk of developing testicular cancer?
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a man who has a brother or father that has had the disease
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What are the two types of testicular cancer?
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1. Seminoma 2. Non-Seminoma
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What is the most important factor for Seminoma?
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the tumor stage
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Seminoma is related to the degree of _________ disease.
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retroperitoneal
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Non-Seminoma is related to the ____ of the disease.
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stage
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True or False: Non-Seminomas tend to be less invasive than Seminomas.
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FALSE: Non-Seminomas tend to be MORE invasive.
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What are the two important factors with non-seminomas?
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1. tumor markers 2. amount of metastases
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What type of non-seminoma carries the worse prognosis?
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choriocarcinoma
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What are the tumor markers for non-ceminomas? (2)
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1. Beta HCG 2. AFP (alpha feta protein)
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What are the 4 symptoms of testicular cancer?
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1. swelling (painless mass or lump) 2. dull ache/heaviness 3. breast tenderness/heaviness 4. infertility
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How often do patients experience advanced symptoms?
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rarely
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What are 2 examples of advanced symptoms?
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1. abdominal pain 2. bloody sputum
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What is the most common symptom associated with testicular cancer?
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- Swelling, painless mass or lump
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What percentage of patient's that present with a painless mass or lump will be malignant in nature?
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96%
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What is important for initial staging?
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Radical Orchiectomy through inguinal incision
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What is removed with a radical orchiectomy?
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- testes - spermatic cord - anything else that is linked to the testes
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What is the "initial management" for testicular cancer?
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- to obtain serum tumor markers: beta HCG & AFP
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If a tumor is suspected what modality should be done?
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ultrasound
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What other modality should be done?
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CT- chest, pelvis, abdomen
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Of the two types of testicular cancers listed previously, which one is more common?
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Seminoma
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What type of tumor cell type is a seminoma?
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classic male germ cell tumor with three subtypes
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What are the three subtypes of the Seminoma, germ cell tumor type?
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1. classic 2. anaplastic 3. spermatocytic
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True or False: Seminomas are very radiosensitive and very curable.
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true!
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What are the 4 types of non-seminomas?
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1. Embryonal cell 2. Teratoma 3. choriocarcinoma 4. yolk sac tumor- embryonal adenocarcinoma
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The yolk sac tumor, embryonal adenocarcinoma can occur in what type of patients?
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children, pre-puberty
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True or false: non-seminomas can be of a mixed histology.
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true
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With a non-seminoma, will you most likely become sterile?
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yes
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What are the three staging systems for testicular cancers? Which ones are the most common?
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1. EORTC 2. UICC (most common) 3. AJCC (most common)
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Pure Seminoma has a ______ tendency to stay localized.
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greater
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How does pure seminoma spread?
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spread is very orderly to lymph nodes/retroperitoneum
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Seminoma begins in the _____________ and moves to the ______.
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Seminoma begins in the inguinal nodes and moves to the abdomen.
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True or False: Seminomas more often have blood borne mets.
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FALSE: Seminomas rarely have blood borne mets (stay more confined to the lymph nodes)
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Non-seminomas are more likely to spread _________ the lymphatics.
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outside
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What are the two most common sites for non-seminomas to spread to?
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Lungs & Liver
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Initial management is to obtain serum tumor markers, AFP & beta HCG, why?
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for baseline #'s after surgery
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How is testicular cancer treated?
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multidisciplinary
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What are the treatment types used in the multidisciplinary approach for treatment of testicular cancer?
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- Surgery - Chemotherapy - Radiotherapy
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What is the goal of the treatment of testicular cancer?
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- minimize toxicity without compromising the opportunity for a curative outcome
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What is the standard treatment for testicular cancers?
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Surgery + Post-OP radiation
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For surgery + Post-op radiation for stage 1 & 2A disease, what type of treatment field is used?
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Hockey Stick--includes the periaortic & ipsilateral pelvic nodes
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Why are the doses lower for stage 1 & 2A disease?
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- more radiosensitive - location (decreases bad side effects)
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What is the total dose & daily dose for Stage 1 & 2A disease?
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Total: 2500 cGy Daily: 160-180 cGy/fx
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What is included in the treatment field for surgery + post-op radiation for stage 2B disease?
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periaortic, ipsilateral pelvic nodes with modificaiton to encompass larger mass
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The more advanced the disease, the more ______ the treatment will be.
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individualized
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For stage 2B disease, your entire nodal volume dose will be ____cGy w/ daily fractions of ________cGy.
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total: 2500 cGy daily: 160-180 cGy/fx
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What is the total dose of a boost for stage 2B disease to residual tumors? daily fractionation?
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total: 500-1000 cGy Daily: 180-200 cGy/fx
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The initial treatment for Non-Seminoma testicular cancer includes:
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- Radical Orchiectomy - Node Dissection (retroperiteum) - + Cisplatin based chemotherapy
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Non-Seminoma patients that recieve chemotherapy will recieve four cycles of:
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- Vinblastine, Bleomycin, Cisplatin (PVB)
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Non-Seminoma patients do not typically recieve radiation, why??
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- irradiation dose not have a role in these tumors EXCEPT in cases of palliative TX for brain mets
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________ of patients have radiographic evidence of diesease following chemotherapy. A. 1/4 B. 1/2 C. 1/5 D. 1/3
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D. 1/3
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What is the technique for radiation for testicular cancer? (there are two techniques used)
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- Inverted Y - Hockey Stick
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When would you used an inverted Y technique????
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if disease was on both sides! hockey stick=used after surgery
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What is the upper RT border?
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T10 & wide enough to include renal hilar nodes
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What is the lower RT border?
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at the top of the symphysis pubis or margin of the inguinal scar (from the orchiectomy)
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Why do you want to make sure your field borders are wide enough?
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wide enough to include bilateral para-aortic nodes + ipsilateral external iliac or by lateral external iliac if inverted Y is treated
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How would you position a patient recieving testicular radiation?
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supine with arms at side, elevated, or above head
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What is something that you do not want to allow the patient to do when setting them up for testicular irradiation??
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no crossing the legs
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Fields must be shaped to avoid _________
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critical structures (MLCs & blocks to avoid these)
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What are some critical structures we used MLCs & blocks to block out?
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- kidney - small bowel - bladder - bone marrow reserves in iliac crests
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What do you do with the other testicle when setting the patient up for radiation?
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-must be shielded from internal scatter radiation - TLD or diode to ensure the effectiveness of the scrotal shield
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What are the 5 radiation side effects?
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1. Skin Irritation 2. Bladder Irritation 3. decrease in sperm production 4. sometimes N & V 5. question of second malignancy
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What would you advise your male patient to do during his treatment?
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- advised to use birth control during RT, not plan pregnancy for at least one year after RT
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What might "bladder irritiation" include?
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- bladder spasms - burning when urinating
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What percentage incidence in second malignancy has been reported?
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5-10%
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What are the 6 Chemotherapy side effects?
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- hair loss - N & V - kidney damage - sterility - secondary malignancy - decreased blood counts
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What type of chemotherapy drugs cause kidney damage & sterility?
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cisplatin based drugs
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What is the survival rate for seminoma, stage 1?
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92-96%
