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Surgery

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Urology

Question
108 out of 129
 

Which is not true about testes tumor



A Pure Seminoma have more aggressive course than non seminoma

B Hematogenous spread is more common in Non seminomas

C Orchidectomy followed by radiotherapy is TOC

D Seminomas follow a more indolent course in comparison to non seminomas , as most of the seminomas present with stage-I.

Ans. D Seminomas follow a more indolent course in comparison to non seminomas , as most of the seminomas present with stage-I.

Spread

a. Seminomas as well as non-seminomas typically metastasize through lymphatics, but non-seminomas may spread through hematogenous route .

b. Choriocarcinoma(non seminoma) in particular demonstrates early hematogenous spread.

c. Lymphatic spread to the retroperitoneal (para aortic) and intrathoracic lymph node. Contralateral paraaortic lymph nodes

d. Sometimes can be involved. Inguinal lymph nodes are affected only if scrotal skin is involved.

e. Pulmonary metastasis(hematogenous) is suggestive of teratoma (non-seminoma).

Prognosis-

Depends on histological type and Stage of the tumor.

Seminoma-

a. No mets - 95% 5 year survival after Rx

b. With Mets - 75%

Teratoma-

a. Stage 1 & 2 - 85% 5 year survival.

b. Stage 3& 4 - 60%

Clinical Features-

Sensation of heaviness is most common presenting symptom

a. Pain (30%), history of trauma (10%).

b. Scrotal lump that can not be felt separate from the testes may be a malignant tumor.

c. Testis is enlarged, smooth, firm and heavy

d. Secondary hydrocele (10%).

Vas is never thickened.

In no other disease is testicular sensation lost so early.

e. 1-5%may have Gynecomastia.

f. Atypical cases- may simulate epididymo-orchitis.

Pain and rapid enlargement may be due to hemorrhage in the neoplasm.

g. Secondary retroperitoneal deposits may be palpable just above and lateral to the umbilicus.

h. Lung mets are usually silent but may cause chest pain, dyspnea and hemoptysis.

i. Liver enlargement or supraclavicular node may be the presenting feature sometimes.

Treatment

Surgical therapy includes orchidectomy and further treatment according to the following table

Table . Germ Cell Tumor Staging and Treatment

Treatment

Stage

Extent of Disease

Seminoma

Non seminoma

IA

Testis only, no vascular/lymphatic invasion (T1)

Radiation therapy

RPLND or observation

IB

Testis only, with vascular/lymphatic invasion (T2), or extension through tunica albuginea (T2), or involvement of spermatic cord (T3) or scrotum (T4)

Radiation therapy

RPLND

IIA

Nodes < 2 cm

Radiation therapy

RPLND or chemotherapy often followed by RPLND

IIB

Nodes 2–5 cm

Radiation therapy

RPLND +/– adjuvant chemotherapy or chemotherapy followed by RPLND

IIC

Nodes > 5 cm

Chemotherapy

Chemotherapy, often followed by RPLND

III

Distant metastases

Chemotherapy

Chemotherapy, often followed by surgery (biopsy or resection)

Urology Flashcard List

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