9- Testicular tumors

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Questions and Answers

What is the recommended approach for a patient with low-volume NSGCT and elevated serum markers?

Surveillance with CT scans

Immediate surgical resection

Nerve-sparing RPLND

Chemotherapy with BEP for 3 cycles (correct)

Which follow-up procedure is typically conducted every one to three months for patients recovering from testicular cancer?

PET scan of the brain

MRI of the pelvis

Bone marrow biopsy

Physical examination and chest x-ray (correct)

What is a common long-term side effect of bleomycin used in cancer treatment?

Testosterone increase

Hearing loss

Lung damage (correct)

Kidney damage

Which treatment approach is typically followed for a residual mass greater than 1 cm if tumor markers are normal?

Surgical resection Signup and view all the answers

What is the primary goal of regular follow-up for testicular cancer patients?

To detect relapse and asynchronous tumors early Signup and view all the answers

What is the percentage of all cancers in men that testicular cancer accounts for?

1-1.5% Signup and view all the answers

Which risk factor is NOT associated with an increased risk of developing testicular cancer?

Obesity Signup and view all the answers

Which type of germ cell tumor is most likely to present in a younger male population?

Classical seminoma Signup and view all the answers

What is the primary characteristic of spermatocytic seminomas compared to classical seminomas?

Less likelihood of metastasis Signup and view all the answers

Which region of the body is least likely to develop germ cell tumors from the testicles?

Cervical spine Signup and view all the answers

What percentage of testicular tumors are pure embryonal carcinomas?

3-4% Signup and view all the answers

Which statement about testicular tumors is accurate regarding their treatment?

Mixed germ cell tumors are treated as non-seminomas Signup and view all the answers

In which demographic is testicular cancer most frequently diagnosed?

Men aged 20 to 45 Signup and view all the answers

Which protein is produced by nonseminomas and is used to track the patient’s response to treatment?

Alpha-fetoprotein Signup and view all the answers

What characteristic best describes choriocarcinoma?

It is likely to metastasize rapidly to distant organs. Signup and view all the answers

Which type of teratoma is more likely to invade surrounding tissues?

Immature teratomas Signup and view all the answers

What is the typical initial diagnosis method for carcinoma in situ (CIS) in testicular cancer?

Biopsy Signup and view all the answers

What distinguishes teratoma with malignant transformation from other teratoma types?

It shows aggressive characteristics and can develop outside the testicle. Signup and view all the answers

Which of the following statements about mature teratomas is true?

They can usually be cured with surgery. Signup and view all the answers

What is the most common treatment recommendation for carcinoma in situ due to its unpredictable nature?

Observation (watchful waiting) Signup and view all the answers

Which of the following is NOT a typical outcome of nonseminomas?

High likelihood of developing into choriocarcinoma Signup and view all the answers

What distinguishes immature teratomas from mature teratomas?

Immature teratomas contain cells resembling early embryonic cells. Signup and view all the answers

What percentage of testicular tumors in children are Leydig cell tumors?

25% Signup and view all the answers

Which of the following statements is true regarding Sertoli cell tumors?

They are usually benign. Signup and view all the answers

In adulthood, what is the most common secondary testicular cancer?

Testicular lymphoma Signup and view all the answers

What is the primary treatment for secondary testicular tumors?

Surgical removal followed by radiation and/or chemotherapy Signup and view all the answers

What is a common symptom of testicular cancer?

Painless lump in the testicle Signup and view all the answers

Which of the following best describes the progression of metastatic spread in testicular cancer?

It can involve para aortic nodes, lungs, and bones. Signup and view all the answers

Which diagnostic method is NOT typically used for testicular cancer staging?

MRI of the pelvis Signup and view all the answers

Which serum markers are commonly assessed in suspected testicular cancer cases?

AFP, bhCG, and LDH Signup and view all the answers

What is a major reason for delayed diagnosis of testicular cancer?

Failure to perform self-examination Signup and view all the answers

What characterizes Leydig cell tumors of the testicle?

They sometimes produce estrogens Signup and view all the answers

What is the prognosis for patients classified under the poor-risk category for advanced testicular cancer?

Approximately 50% chance of successful treatment Signup and view all the answers

Which of the following factors does NOT influence the prognosis and treatment options for testicular cancer?

Number of surgical interventions previously undergone Signup and view all the answers

What is the recommended treatment for clinical Stage IA NSGCT?

Nerve-sparing retroperitoneal lymph node dissection (RPLND) or primary chemotherapy Signup and view all the answers

What is the treatment protocol for a patient diagnosed with low-volume seminoma at Stage II?

Radiotherapy (30-36 Gy); chemotherapy as salvage therapy if needed Signup and view all the answers

For high volume seminoma at Stage II, what is the recommended treatment approach?

3 cycles of BEP chemotherapy Signup and view all the answers

In Stage III testicular cancer, what signifies a more advanced stage of the disease?

Metastasis to lungs, liver, brain, and bones Signup and view all the answers

What is the purpose of conducting nerve-sparing retroperitoneal lymph node dissection (RPLND) in clinical Stage IB NSGCT?

To evaluate lymph node disease and determine further treatment Signup and view all the answers

In the context of advanced testicular cancer, what does the term ‘good-risk’ refer to?

Patients with a high probability of treatment success Signup and view all the answers

Which of the following is a key marker evaluated for testicular cancer prognosis?

Lactate dehydrogenase (LDH) Signup and view all the answers

Study Notes

Testicular Tumors

Testicular cancer is a common solid tumor in young men, affecting them in their 30s and 40s.
It's relatively rare, comprising 1-1.5% of all cancers in men.
It's highly treatable and often curable.
Testicles have different cell types, each potentially developing cancer with varying prognoses and treatments.

Testicular Cancer Risk Factors

Age: Most prevalent between 20 and 45.
Family history: Increased risk with family history.
Personal history: Having cancer in one testicle raises the risk in the other.
Race: White men have a higher rate of diagnosis.
Cryptorchidism: Undescended testicles increase risk.
Klinefelter syndrome: Extra X chromosome; lowers male hormones, affecting fertility, and increasing risk of germ cell tumors.
HIV infection: HIV infection linked to an increased risk.
Maternal estrogen exposure: Potential link to increased risk.

Testicular Cancer Pathology

Over 90% of testicular cancers originate in germ cells (sperm-producing cells).
Germ cell tumors commonly begin in the testicles but can spread to other parts of the body (retroperitoneum, mediastinum, lower spine, pineal gland).
Two main types of germ cell tumors:
- Seminomas
- Non-seminomas (NSGCT)
- Some cancers contain both, treated as non-seminomas.

Seminomas

Two main subtypes:
- Classical (typical): Most common, affecting men in their late 30s to early 50s.
- Spermatocytic: Affects older men (55+). Tends to grow more slowly and isn't as likely to spread as classical seminomas.

Non-seminomas (NSGCT)

Embryonal carcinoma: Accounts for about 40% of testicular tumors overall, but pure embryonal carcinomas are rare (~3-4%). Grows quickly and spreads outside the testicle.
Yolk sac carcinoma: Most common in children. Looks like the yolk sac of a human embryo. Highly responsive to chemotherapy. AFP protein, found in the blood, helps diagnose and track treatment.
Choriocarcinoma: Very rare and aggressive. Often affects adults. Highly likely to spread to distant organs (lungs, bones, brain). Less common as a pure form. Usually found with other tumor types. HCG protein used for diagnosis and treatment monitoring.

Mature and Immature Teratomas

Mature teratomas: Formed from adult tissue cells. Spread is infrequent, surgery is typical treatment.
Immature teratomas: Cells resemble early embryo tissue, increasing the likelihood of invasion and spread beyond the testicle. Can recur years post-treatment.
Teratomas with malignant transformation: Highly rare. Some tissue areas may change to cancer types that originate elsewhere in the body (muscles, lungs, intestines, brain).

Carcinoma in Situ (CIS)

Early stage of testicular cancer, non-invasive.
Found with biopsies, often incidentally.
Doesn't always progress to invasive cancer, observation or watchful waiting is sometimes the best strategy.

Stromal Tumors

Less common, about 4% of adult cases but account for up to 20% in children.
- Leydig cell tumors: Originate from Leydig cells, produce androgens and sometimes estrogen. Often localized and cured with surgery. Poor prognosis if they spread.
- Sertoli cell tumors: Develop from Sertoli cells supporting germ cells. Usually non-cancerous; resistance to chemotherapy and radiation if they spread.

Secondary Testicular Tumors

Other cancers can spread to the testes from other sites.
Testicular lymphoma is common in older men (over 50).
Prognosis depends upon the specific cancer type and stage.
Leukemia cells can occasionally form tumors in the testes.

Testicular Cancer Metastatic Spread

Common routes include para-aortic nodes, lungs, brain, and bones.
Retroperitoneal nodes are often involved.

Testicular Cancer Diagnosis Delay

Patient avoids self examination and medical attention.

Testicular Cancer Staging

Stage 0 (Carcinoma in situ): Early, non-invasive cancer.
Stage I: Cancer limited to the testes.
Stage II: Cancer has spread to lymph nodes in the abdomen.
Stage III: Cancer has spread to other body organs such as lungs, liver, brain, and bones.
Specific staging systems (e.g. TNM, Walter Reed) exist to precisely document aspects of the disease.
Multiple staging, or tumor, markers (i.e. LDH, AFP, βhCG) aid in diagnosis and prognosis.

Testicular Cancer Treatment Options

Treatment protocols depend on: stage, type of cancer, tumor size, and existence and extent of retroperitoneal lymph nodes.
Risk group classification based on treatment success rates (e.g., good, intermediate, poor).
- Poor-risk cancers retain a 50% chance of successful treatment.
Specific treatment (surgery, radiation, chemotherapy) depends on the type and stage for seminomas and nonseminomas.

Testicular Cancer Follow-up

Crucial for early detection of relapse.
Frequency and duration of follow-ups depend on the cancer histology, stage and specific treatment approach.
A key goal of follow-up is to detect possible secondary or synchronous cancers in the other testicle.

Testicular Cancer Side Effects

Anemia
Diarrhea
Hormone deprivation (men)
Infections
Nervous system disturbances
Sexual dysfunction
Skin problems
Long-term effects: lung, kidney, blood vessel damage, hearing and nerve damage
Secondary cancers
Infertility
Testosterone level effects

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Description

This quiz covers essential information about testicular tumors, including their prevalence, risk factors, and pathology. Learn about the different types of cells involved and how family history and other conditions can influence risk. Gain insights into this important health topic relevant for young men.