TAILIEUCHUNG - Chapter 092. Testicular Cancer (Part 5)

Postchemotherapy Surgery Resection of residual metastases after the completion of chemotherapy is an integral part of therapy. If the initial histology is nonseminoma and the marker values have normalized, all sites of residual disease should be resected. In general, residual retroperitoneal disease requires a modified bilateral RPLND. Thoracotomy (unilateral or bilateral) and neck dissection are less frequently required to remove residual mediastinal, pulmonary parenchymal, or cervical nodal disease. Viable tumor (seminoma, embryonal carcinoma, yolk sac tumor, or choriocarcinoma) will be present in 15%, mature teratoma in 40%, and necrotic debris and fibrosis in 45% of resected specimens. The frequency of. | Chapter 092. Testicular Cancer Part 5 Postchemotherapy Surgery Resection of residual metastases after the completion of chemotherapy is an integral part of therapy. If the initial histology is nonseminoma and the marker values have normalized all sites of residual disease should be resected. In general residual retroperitoneal disease requires a modified bilateral RPLND. Thoracotomy unilateral or bilateral and neck dissection are less frequently required to remove residual mediastinal pulmonary parenchymal or cervical nodal disease. Viable tumor seminoma embryonal carcinoma yolk sac tumor or choriocarcinoma will be present in 15 mature teratoma in 40 and necrotic debris and fibrosis in 45 of resected specimens. The frequency of teratoma or viable disease is highest in residual mediastinal tumors. If necrotic debris or mature teratoma is present no further chemotherapy is necessary. If viable tumor is present but is completely excised two additional cycles of chemotherapy are given. If the initial histology is pure seminoma mature teratoma is rarely present and the most frequent finding is necrotic debris. For residual retroperitoneal disease a complete RPLND is technically difficult owing to extensive postchemotherapy fibrosis. Observation is recommended when no radiographic abnormality exists on CT scan. Positive findings on a positron emission tomography PET scan correlate with viable seminoma in residua and mandate surgical excision or biopsy. Salvage Chemotherapy Of patients with advanced GCT 20-30 fail to achieve a durable complete response to first-line chemotherapy. A combination of cisplatin ifosfamide and vinblastine VelP will cure about 25 of patients as a second-line therapy. Substitution of paclitaxel for vinblastine may be more effective in this setting. Patients are more likely to achieve a durable complete response if they had a testicular primary tumor and relapsed from a prior complete remission to first-line cisplatin-containing chemotherapy. In .

• Y học thường thức
• Testicular Cancer
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu y khoa
• Harrisons Internal Medicine
• BMC Cancer
• Testicular cancer survivors
• Germ cell tumors
• Premature aging
• Molecular aging
• Patient education websites
• Germ cell tumor
• Testicular malignancy
• Testicular germ cell tumour
• Non seminoma
• Frequent cannabis
• Tumor inflitrating neutrophil
• Prognostic value
• Testicular germ cell tumors
• Overall survival
• Health belief model
• Fasa city
• Social support
• Testicular self examination
• Cancer survivors
• Metabolic syndrome
• Cardio metabolic risk factors
• Racial differences
• Highest incidence rates
• Asians and Pacific Islanders
• Testicular germ cell cancer
• Cisplatin sensitivity
• Germ neoplasia in situ
• Undergo malignant transformation
• Mild Leydig cell insufficiency
• Testosterone substitution
• Hormonal disturbance
• Physical activity
• Increased adult height
• Risk factor
• Androgenic alopecia
• Prostate cancer
• Testicular germ cell tumor
• Meta analysis
• Health related quality of life
• Psychometric validation
• Patient reported outcome
• Germ cell neoplasia in situ
• Fibrillin 1
• Testicular germ cell tumours
• Cancer pathogenesis
• Nodal and Activin signalling
• Expression of pluripotency factors
• Germ cell cancer
• Germ cells
• Anti tumoral
• Anti angiogenic multikinase inhibitor
• Primary testicular lymphoma
• Diffuse large B cell lymphoma
• Initial treatment
• Therapy outcome
• Systemic chemotherapy
• Pure seminoma
• Semi quantitative score
• Testicular impairment
• Antioxidant enzymes
• Reproductive hormones
• DNA damages