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15 Cards in this Set

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What is the most common cause for solic tumors in 20-35 year olds?
Germ Cell Tumors!

Incidence of 9,000.
What are the FOUR kinds of non-seminoma GCT's?
1) Yolk sac tumor
2) Choriocarcinoma
3) Embryonal carcinoma
4) Terratomas
How do you surgically evaluate testicular cancer?
Ultrasound.

Then, if removal and prognosis needed, perform RADICAL INGUINAL ORCHECTOMY... Don't go through scrotum because can damage and push cancer cells into INGUINAL LYMPH NODES.
How do you treat Stage 1 patients?
SEMINOMA: Radiation
NSGCT: RPLND

95%-100% 5-year survival if STAGE 1.

70% of seminomas are STAGE 1
How do you treat Stage 2?
SEMINOMA: XRT + Chemotherapy.
NSGCT: RPLND + chemo


Stage 2 means metastases have reached the RETROPERITONEUM. Typical ipsilateral flank pain.

90-95% 5-yr survival.
How do you treat stage 3?
Chemotherapy and surgical resection.

Stage III means metastases have traveled BEYOND retroperitoneum.
What is a typical CHEMO agent?

What are potential toxicities?
CISPLATIN. Increased platinum levels in patients for decades!

IMMEDIATE SIDE-EFFECTS:
1) Emesis
2) Fatigue
3) Myelosuppression (rarely severe)
4) Nephrotoxicity, ototoxicity, neuropathy

LONG-TERM
1) Cardiovascular disease due to increase platinum levels.
What are important AFP and hCG levels in determining RISK LEVEL for patients?
GOOD RISK
<1000 AFP and hCG < 5000.
90% survival

INTERMEDIATE RISK
1000<AFP<10,000 and 5000<hCG<50000
80% survival

POOR RISK:
AFP>10,000 hCG >50,000
45-50% survival
What percentage of patients are azospermic upon completion of CHEMO?
100%. ~80% will recover sperm levels within 3-4 years.

HIGHLY RECOMMENDED to freeze sperm.
What percentage of MALIGNANT TESTICULAR TUMORS are GCT's?
~95%
If AFP levels are obtained in analysis, this must be what kind of GCT?
NON-SEMINOMA.

hCG can be in EITHER NON or SEMINOMA.
What is in the differential for testicular swelling/pain.
Orchitis (mumps). Hydrocele. Varicoele. Epididimytis.
What is a toxicity associated with BLEOMYCIN.
Pulmonary toxicity.
What is a good test to locate tumor progression?
PET. Measures glucose utilization. CANCER CELLS have higher rates.

ONLY GOOD FOR SEMINOMAS
For NSGCT's, what is usually performed AFTER CHEMO?
Post-chemo resection of residual disease.

In NSGCT's, there is NO WAY to determine if remaining cells are live/dead tumors cells, etc. Removal of these products increases likelihood of survival.