With regards to testis preserving surgery in testis cancer, which of the following is FALSE?
Answer D
Tumour volume should be <30%. Indications are A & B. As these are uncommonly indicated, they should be performed in high-volume centres with expertise to use intra-operative ultrasound localisation or by bi-valving the testis after soft clamps are used to occlude the blood supply (the Chevassu procedure).
Which of the following is NOT an adverse prognostic marker in stage I nonseminomatous germ cell tumour?
Answer B
Vascular/lymphatic invasion, proliferation rate >70% and percentage of embryonal carcinoma >50% are all prognostic markers for occult metastatic disease in non-seminoma stage I. Absence of teratoma can also independently complement vascular invasion.
Tumour size (>4 cm) is an adverse prognostic marker for stage I seminoma along with rete testis invasion.
With regards to risk stratification in germ cell tumours, which of the following is FALSE?
Risk stratification is evidence-based. In NSGCT tumours with low risk disease (i.e., without vascular/lymphatic invasion), recurrence rate is approximately 20% compared to 50% for high risk disease (with vascular/lymphatic invasion) and an overall rate of 30% (Read et al. Journal of Clinical Oncology 1992 and Albers et al. Journal of Clinical Oncology 2003). In seminomatous tumours, low-risk disease (i.e., no adverse features like rete testis invasion and tumour <4 cm), recurrence is 12%, and if one risk factor is present, it is approximately 16%, and if both are present, it is 32%, giving an overall recurrence rate of 20%. It is important to note that whilst we all use these features, this is from a large retrospective series and has not been shown prospectively. The data from the TRISST study will help with this. Single-dose carboplatin chemotherapy or traditional ‘dog-leg’ radiotherapy reduces the risk recurrence to approximately 4% in seminoma.
Regarding the histology of nonseminomatous germ cell tumours, which of the following is associated with an increased risk of metastasis in cases apparently stage 1 at presentation?
The key histological parameter in determining risk of occult metastatic disease in NSGCT is lymphovascular invasion (LVI) with 48% developing metastases in LVI is present compared to 14% for those without LVI.
Which of the following is TRUE of metastatic seminoma?
Answer A
Pure seminoma’s and choriocarcinoma do not produce AFP.
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