Testicular CA I Case1: Adjuvant/Genetic I Case2: Non seminoma I Case3: Seminoma I Case 4: Metastasis

CASE 1
This patient has Stage IIB disease (Any T, N2 disease as lymph node mass is between 2-5 cm).
An AFP less than 1000 ng/ml and BHCG less than 5000 is S1. This does not upstage him though. He has Good risk disease.
Either EP x 4 cycles or BEP x 3 cycles should be given.
compared to adult solid tumors such as lung, kidney, and bladder that have mutation rates between 8–11 mutations/megabase, the mutation frequency of TCGTs is much lower at approximately 0.5 mutations/megabase. The only consistent chromosomal abnormality of TGCT The presence of an isochromosome of chromosome 12
this chromosomal bnormality Can be used as a diagnostic molecular marker for seminomas and nonseminomas as well as in the workup of Cancer of Unknown primary
Other Chromosomal Abnormalities associated with TGCTs have also been reported such as Increase in copy numbers of chromosomes 7, 8, 17, and X and decreases in copy numbers of chromosomes 4, 11, 13 and 18.

Reference: http://www.nccn.org/profession....als/physician_gls/pd
Woldu SL, Amatruda JF, Bagrodia A. Testicular germ cell tumor genomics. Curr Opin Urol. 2017 Jan;27(1):41-47..


CASE 2.
Patients with stage IS non-seminoma exhibit persistent elevation of serum tumor markers post-orchiectomy, but no radiographic evidence of disease.
Stage IS is defined by:
Any pT/Tx, N0, M0, S 1-3
The treatment for IS disease is either BEP x 3 cycles or EP x 4 cycles

Reference: https://www.nccn.org/professio....nals/physician_gls/p

CASE 3.
A persistently elevated hCG level during and upon completion of treatment for metastatic testicular cancer defines an incomplete response to chemotherapy, and is associated with a very poor outcome. However, a false elevation of hCG have also been reported on and must be considered in the differential diagnosis. Marijuana use and abnormal renal function have been reported to cause false-positive elevations of hCG. Another frequent, nonmalignant cause of a persistent, falsely elevated hCG level is hypogonadism. Reduced testosterone production, either as a consequence of orchiectomy or chemotherapy, can result in compensatory production of LH by the pituitary gland. The elevated level of LH causes a cross reaction with the antibodies in the hCG immunoassay, as the two hormones share common amino acid sequences. Testosterone inhibits LH production, thus reducing the LH level, which in turn should result in normalization of a falsely elevated hCG level
Another potential cause of a false-positive hCG test is the presence of IgG immunoglobulins in the serum that mimic immunoreactivity, termed heterophile antibodies. Heterophile antibodies are antibodies against external antigens, such as those originating in animals, that cross react with self-antigens, and are present in 3–15% of healthy individuals.1 Most commercially available hCG tests are two-site immunoassays that use two animal antibodies against human hCG. Heterophile antibodies cause false positives by forming a bridge between the capture antibody and the labeled antibody used in the immunoassay, thus mimicking the role of hCG

Reference: Gallagher DJ, Riches J, Bajorin DF. False elevation of human chorionic gonadotropin in a patient with testicular cancer. Nat Rev Urol. 2010 Apr;7(4):230-3. doi: 10.1038/nrurol.2010.10. PMID: 20383188


CASE 4.
This is A T4N0M1b intermediate risk seminoma (Nonpulmonary visceral metastasis).
AND THE TERAMENT FOR Stage IIC and Stage III Seminoma:
1) Good risk: EP x 4 cycles or BEP x 3 cycles
2) Intermediate risk Seminoma: BEP x 4 cycles or VIP x 4 cycles

Reference: https://www.nccn.org/professio....nals/physician_gls/p

• Category

  Unknown Primary