Multiple Choice Questions MCQ

Question 5# Print Question

Regarding germ cell neoplasia in situ (GCNIS), which of the following is TRUE?

A. Overall incidence in the contralateral testis is approximately 10%

B. Incidence of a contralateral metachronous tumour is approximately 10%

C. Biopsy of the contralateral testis is mandatory in most cases

D. Chemotherapy is more effective than radiotherapy in its treatment

E. Five-year risk of developing testicular cancer is 90% with a normal contralateral testis

Question 1# . Regarding orchidectomy for testicular cancer, which of the following is TRUE?
A. Testicular prosthesis can be inserted without fear of prohibitive infectious complications
B. Division of the spermatic cord must be taken at the superficial inguinal ring
C. In cases of symptomatic metastatic disease orchidectomy should precede chemotherapy
D. Organ-sparing surgery can be performed when tumour volume is less than 50%
E. Long-term risk of silicone implants is well known
Answer A From a large series of testicular prosthesis insertions at radical inguinal orchidectomy (Robinson et al., BJUI 2016) 33 of 885 patients were re-admitted with a variety of post-op complications including infection within 30 days. However, only 1 out of 236 patients (0.4%) required prosthesis removal. The spermatic cord is tied and excised at the deep inguinal ring. Symptomatic metastatic disease is an oncological emergency and first line treatment should be expedited chemotherapy. The guidelines for organ-sparing surgery involve the tumour volume to be less than 30%. The long-term risks of silicone implants remain unknown despite the controversy with breast implants.

Question 2# Regarding testicular cancer, which of the following is TRUE?
A. Incidence is 2 per 100,000 males in Western countries
B. 3%–5% are bilateral at diagnosis
C. Magnetic resonance imaging is the imaging of choice for diagnosis
D. Magnetic resonance imaging is more sensitive than ultrasound for diagnosis
E. Tumour markers provide no prognostic information
Answer D The incidence of testicular cancer is 10 per 100,000 and 1%–2% are bilateral. Although ultrasound (US) of the testes has a sensitivity of almost 100% MRI is still more sensitive and specific but its cost-effectiveness over US is not justifiable. The IGCCCT (International Germ Cell Cancer Collaborative) prognostic-based staging system utilises AFP, HCG and LDH to determine different prognostic groups for metastatic tumours and the TNM classification uses tumour markers for their staging S groups

Question 3# In the staging & diagnosis of testicular cancer, which of the following is TRUE?
A. CT thorax, abdomen & pelvis is recommended in all patients
B. Discuss sperm banking in all men after orchidectomy
C. Five-year survival for ‘good prognosis’ seminoma is 96%
D. In the TNM staging classification pN2 means a lymph node mass >5 cm
E. In the TNM staging classification M1b means non-regional lymph node(s) or lung metastasis
Answer A Sperm banking must be discussed in all men before orchidectomy and chemotherapy in cases of delayed orchidectomy due to a significant number of these patients have poor quality semen analysis across the board preoperatively. The five-year survival for good prognosis classical seminoma is 86%. M1a is correct answer as M1b is distant metastases other than non-regional lymph nodes such as brain metastases.

Question 4# Regarding tumour markers in testicular cancer, which of the following is TRUE?
A. HCG has a half-life of 5–7 days
B. AFP has a half-life of 48–72 hours
C. In non-seminomatous germ cell tumours an HCG of 5,000 confers poor prognosis
D. Pure seminomas never secrete AFP
E. In seminomas an HCG >50,000 confers poor prognosis
Answer D HCG has a half-life is 48–72 hours whereas AFP has a half-life of 3–5 days. HCG level of 5,000–50,000 confers intermediate prognosis in the IGCCCT prognostic grouping and there is no poor prognostic group for pure seminomas.

Question 5# Regarding germ cell neoplasia in situ (GCNIS), which of the following is TRUE?
A. Overall incidence in the contralateral testis is approximately 10%
B. Incidence of a contralateral metachronous tumour is approximately 10%
C. Biopsy of the contralateral testis is mandatory in most cases
D. Chemotherapy is more effective than radiotherapy in its treatment
E. Five-year risk of developing testicular cancer is 90% with a normal contralateral testis
Answer A Overall incidence of GCNIS in the contralateral testis is approximately 10% with a 50% fiveyear risk of developing testicular cancer. Incidence of a contralateral metachronous tumour is approximately with current EAU guidelines identified risk factors for detecting GCNIS which is the reason to biopsy the contralateral testis and found that patients presenting younger than 31 years of age, and those with a small testis (<12 mL), history of undescended testes, or poor spermatogenesis (Johnsen score of 1–3) had higher rates of GCNIS that could be as high as 34%. Radiotherapy is the treatment of choice for confirmed GCNIS and is given at a dose of 16–20 Gy in fractions of 2 Gy. If patient is undergoing post-orchidectomy chemo, then there is a 66% chance of treating ITGCN, and a rebiopsy after 2 years would be sensible.