Testicular carcinoma

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The diagnosis and treatment options for testicular carcinoma from Dr. Shanzah Shahbaz, a medical oncologist. This comprehensive guide covers staging, tumor markers, false elevation risks, chemotherapy regimens, and management of residual masses.

Uploaded on Dec 21, 2023 | 2 Views

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  3. Treatment is by stage

  4. Complete staging workup is mandatory before start of treatment. Contrast enhanced CT/scan of abdomen and pelvis CXR-PA View Chest CT if: positive abdomen CT or abnormal chest x ray Brain MRI ,if clinically indicated Neurological symptoms, Extensive lung metastasis, Non- pulmonay visceral metastases, beta-hCG > 5000 IU/L

  5. Tumour markers, (Post-Orchiectomy) AFP ( half life 3 to 5 days) B-HCG ( 24 to 48 hours) LDH

  6. Be Aware Of False Elevation AFP: Liver disease, Hepatocellular carcinoma, Carcinoma of Pancreas, Stomach B-HCG : Chemotherapy related hypogonadism, Marijauna use, Cross reactivity with LH , Hyperthyroidism, Gastrointestinal cancers

  7. Chemotherapy regimens BEP ( Bleomycin, Etoposide, Cisplatin ) X 3 cycles Pulmonary Toxicity , Low Fi02 and hydration because of decreased DLCO during aneathesis EP ( Etoposide, Cisplatin) X 4 Cycles Myelosuppression, Nephrotoxicity, Neuropathy VIP ( Etoposide, Ifosfamide, Cisplatin) X3 cycles Myelosuppression, Highly emetogenic

  8. Management of residual masses (Seminoma) Normalization of LDH, BHCG No residual mass more than 3 cm Residual mass more than 3 cm Residual mass more than 3 cm FDG-PET PET POSITIVE PET NEGATIVE Consider RT to or resection of FDG- avidmass Surveillance surveillance

  9. Management of residual masses ( Non-Seminoma) Normalization of LDH, B-HCG, AFP No residual masses more than 1 cm Raised tumour marker Surveillance Residual mass More than 1 cm Second line chemotherapy Retroperitoneal lymph node dissection

  10. Follow up Late relapses are common with pure seminoma and teratoma Young Patient followed for long term complications . Cardiovascular disease Secondary malignancies Infertility

  11. Thankyou

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