Diagnostic Demons
This is the procedure by which testicular cancer is diagnosed.
What is an inguinal orchiectomy?
Do NOT biopsy the testes
This is the recommended treatment for Stage I seminoma (limited only to testes).
What is surveillance, 20 grays radiation, or 1-2 cycles of single agent carboplatin;
guidelines recommend surveillance
What is the other name for Kadcyla?
What is TDM1 = traztuzumab emtansine
famtraztuzumab/TDXD = enhertu
These are risk factors for testicular cancer.
What are Crytoprochicsm, Klinefelters, 47XXY, Isochromose 12p, famikly/personal hx of testes cancer, infertility?
These are contraindications to bleomycin
What are older age (>50) or reduced GFR, smoking hx also a consideration
This is recommended as part of staging if someone has a very high BHCG.
What is an MRI Brain?
For patients with a nonseminoma, a brain MRI should be performed if the patient has any of the following features:
beta-hCG is >5000 IU/L
Extensive lung metastasis
Predominant choriocarcinoma component
Neurologic symptoms
Non-pulmonary visceral metastasis
AFP >10,000 ng/mL.
BEP X 3 or EP x 4 are options for this stage seminoma.
This is the risk level of prostate cancer at which one starts ADT.
What is unfavorable intermediate risk prostate cancer (and higher)?
Intermediate risk factors T2B, Grade group 2 or 3 (Gleason score 7, 3+4, or 4+3 respectively), or PSA > 10-20?
Unfavorable intermediate risk: 2 or 3 intermediate risk factors, grade group 3 (4+3), > 50% of core biopsy positive
T/F Primary Mediastinal Seminoma is treated as good risk seminoma.
True
Primary Mediastinal Nonseminoma is treated as poor risk
This makes someone a cisplatin candidate
What are
Creatinine clearance > 60
ECOG 0 or 1
Hearing loss: There should be no grade 2 or higher hearing loss.
Neuropathy: There should be no grade 2 or higher neuropathy.
Heart failure: There should be no New York Heart Association (NYHA) Class III heart failure.
?
A patient with seminoma with retroperitoneal lymph nodes but normal tumor markers, represents this stage.
Stage II
Staging
1- Testes only, LVI increases risk of relapse
2 - retroperitoneal lymph nodes, afp < 1000, HCG < 5000
3 - pelvic lymph nodes, bone liver lung, OR if poor risk tumor markers
This is the treatment for intermediate seminoma or intermediate/poor risk seminoma
BEP X 4 OR VIP X 4
This is the transplant criteria for patient's with HCC
What is single tumor < 5 cm or up to 3 tumors < 3 cm, no macrovascular invasion or metastasis; liver function does not matter.
Milan criteria
This is likely the diagnosis if you have a growing mass while a patient with nonseminoma is receiving chemotherapy
What is growing teratoma syndrome?
Tx Surgery
If someone develops toxicity while on Bleomycin, this is the recommendation.
What is if good risk, drop bleomycin, if intermediate/poor then switch to iphosphamide
For advanced seminoma, this constitutes the risk stratification between good and intermediate risk seminoma.
What is the presence of non pulmonary mets?
Good - pulm mets only
Intermediate - nonpulmonary mets
If primary mediastinal, then would treat as good risk
TUMOR MARKERS DO NOT MATTER
If you have residual disease in a seminoma patient, this is the next step of management.
What is a PET scan?
If residual mass > 3 cm, do PET,
if negative surveil; If positive, biopsy - Radiation, surgery or additional chemo EP x 2 or VIP
NO PET FOR NONSEMINOMA (radioresistant) - lymph node dissection instead
Alemtuzumab targets which CD?
What is CD52?
Elotuzmab targets SLAMF7
These are your options for Stage I nonseminoma
What is surveillance or RPLND or chemo?
For stage IIa,
if lymph nodes are less than 2 cm and less than 5 lymph nodes- observe
If > 2cm and > 6 lymph nodes - BEP X 2
Acute Myeloid Leukemia from topoisomerase inhibitors such as etoposide arise from this mutation.
What is 11q23?
These are the levels of AFP, HCG, LDH needed to classify one as poor risk nonseminoma.
What is S3 - AFP > 10k, HCG > 50k, LDH > 10K?
S1 - AFP < 1000, HCG < 5000, LDH < 1.5 X upper limit
S2 - AFP - 1000-10K, HCG 5000 - 50K, LDH > 1.5
S3 - AFP > 10k, HCG > 50k, LDH > 10K
Good risk S1 or pulm mets only
Intermediate - pulm mets or S2
Poor risk - nonpulm mets and S3 or nonretroperitoneal, mediastinal primary
These are salvage regimens for nonseminoma.
What is
TIP - paclitaxel, iphosphamide and cisplatin
VEIP - vinblastine, iphosphamide, and cisplatin, followed by autologous transplant
?
Of the following, these drugs are safe during 2nd/3rd trimester pregnancy (one is unclear)
Traztuzumab, Adriamycin, Cyclophosphamide, Paclitaxel
There are reports that trastuzumab can lead to oligohydramnios when it is administered to a pregnant patient. This medication is contraindicated to give to a pregnant patient who presents with Her2+ breast cancer.
Adriamycin/Cyclophosphamide have both been shown to be safe to administer to a pregnant patient during the 2nd and 3rd trimesters of pregnancy. The safety of administering
Taxol to a pregnant patient who has breast cancer is more unclear
Marijuana can increase this tumor marker level
What is BHCG?
These are side effects of iphosphamide
What are Myelosuppression, CNS toxicities (coma/death), Nephrotoxicity, Hemorrhagic cystitis (Mesna to prevent), Interstitial pneumonitis, pulmonary fibrosis, and other forms of pulmonary toxicity, --Secondary malignancies, --Cardiotoxicity?