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Testicular cancer q - odin
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07-19-2012, 08:25 AM
A 24-year-old man presents with a lump in his right testicle. An ultrasound is done that confirms the presence of a 2-cm nodule. A computed tomography (CT) scan of the abdomen and pelvis are normal. Serum tumor markers reveal a β-human chorionic gonadotropin (β-hCG) of 500 mIU/mL (normal:
07-19-2012, 03:00 PM
Sounds like a pure seminoma! But there's obviously missing info from the question.
07-19-2012, 07:14 PM
A 24-year-old man presents with a lump in his right testicle. An ultrasound is done that confirms the presence of a 2-cm nodule. A computed tomography (CT) scan of the abdomen and pelvis are normal. Serum tumor markers reveal a β-human chorionic gonadotropin (β-hCG) of 500 mIU/mL (normal: less than 5) and a serum α-fetoprotein level of 200 mIU/mL (normal: less than 15). He undergoes inguinal orchiectomy, which reveals tumor limited to the testis. The pathology reveals a seminoma. Which of the following is the most appropriate for this patient?
A. Radiation therapy B. Radiation therapy plus chemotherapy with bleomycin/etoposide/cisplatin (BEP) C. Chemotherapy with BEP D. Retroperitoneal lymph node dissection (RPLND)
07-19-2012, 10:03 PM
Hi Odin, great question. I guess RPLND will be better as a salvage therapy?
even though the tumor is primarily limited to testis and as it has been taken out theres no point of going thru the other three options. let me know if i am in wrong page. Thanks.
07-20-2012, 08:41 AM
testicular tumours are radiosensitive..so i would go with A.
07-20-2012, 06:31 PM
Well, I am 100% certain that the modern day correct treatment for this is C. with chemotherapy alone being the only treatment. Testicular seminoma tumors are definitely radiosensitive but the number of radiation treatments that the patient has to undergo is high compared to the few chemotherapy treatments in order to get almost the exact same result, so chemotherapy is used today. I know this because my best friend is a radiation oncologist and because a recent close relative of mine just went through this treatment for testicular cancer/seminoma. I don't know when this question was written, so its possible that the answer key gives another answer but modern day its definitely C all the way! See the following article:
http://www.everydayhealth.com/testicular...erapy.aspx
07-21-2012, 11:00 AM
This question is total nonsense and we are not required to know these for step 3. Where are you posting these from? Is this q for oncology boards?
Testicular cancer treatments are very complicated. But what they want us to know in this question is the elevated AFP. Elevated AFP is not Pure Seminoma ( it is in Archer oncology) . So this must be treated like Non Seminomatous germ cell tumor. That much we should know! Where is post op staging? what is t stage of the tumor ? Where are repeat markers after orciectomy? did they normalize or still elevated ? There is no such info in this question  If it is stage IA , two options close observation or RPLND. In this poorly framed question, the most suitable answer is D . D is not needed for early seminoma
07-23-2012, 07:36 AM
i think qs is about stage 1A,( though info may not be complete)
after orchiectomy....most appropriate tx optpions are survielence,radiation,chemotherapy, but not RPLND.
07-23-2012, 07:44 AM
sublimation, this is not Seminoma. Pathology shows seminoma but when AFP is elevated, it is always treated as Non Seminomas.
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