160 - Testicular cancer Mcqs with answers - part 2

6q: all of the following are true about GCTs of testis except ?


a. GCTs are divided into seminomas and non-seminomatous subtypes
b. Non-seminomatous subtypes are most common in the third decade of life
c. Seminomatous subtypes are most common in the fourth decade of life
d. Seminomas represent about 90% of all GCTs
e. Nonseminomas have an aggressive course whereas seminomas have an indolent course

answer d . seminomas represent about 50 % of all GCTs, not 90 %

7q: all of the following are true about non-seminomatous type of GCTs except ?


a. non-seminomas include four histologies : embryonal carcinoma, teratoma, choriocarcinoma and endodermal sinus (yolk sac tumor)
b. choriocarcinoma is associated with the secretion of HCG
c. endodermal sinus (yolk sac tumor) is associated with the secretion of AFP
d. pure embryonal carcinoma AFP or HCG or both .
e. nonseminomatous GCTs metastatize lately to sites such as retroperitoneal lymph nodes and lung parenchyma

answer e , is wrong because nonseminomatous GCTs metastatize early to these sites

8q: all of the following are true about seminomatous type of GCTs except ?


a. they are more common in the fourth decade
b. constitute about 50 % of all GCTs and 70 % of patients present with stage I disease
c. seminomas have an indolent course
d. chemotherapy is the treatment of choice in patients with stage I disease and stage II disease where the nodes are less than 5 cm in maximum diameter.
e. When a tumor contains both seminoma and nonseminoma components, patient management is directed by the more aggressive nonseminoma component.

answer d , is wrong because radiation therapy is the treatment of choice in patients with stage I disease and stage II disease where the nodes are less than 5 cms in maximum diameter

9q: find the false statement ?


a. Approximately 70% of patients presenting with disseminated nonseminomatous GCT have increased serum concentrations of AFP and/or hCG
b. AFP concentrations are increased only in nonseminomas where as HCG levels may be increased in both seminomas and nonseminomas
c. Presence of an increased AFP level in a seminoma patient indicates that an occult nonseminomatous component is also present .
d. LDH levels are not as specific as AFP or hCG but are increased in 50–60% patients with metastatic nonseminoma and in up to 80% of patients with advanced seminoma.
e. After orchidectomy the increased AFP and HCG levels decay according to first order kinetics . half life is 24-36 hrs for AFP and 5-7 days for HCG .

answer e , is wrong because the half life of AFP is 5-7 days and half life of HCG is 24-36 hrs

10q: all of the following statements about treatment of Germ cell tumors of testis are true except ?


a. stage IA, IB and stage IIA, IIB, IIC seminomas all are treated with radiation therapy
b. stage III seminoma is treated with chemotherapy
c. Regardless of histology, patients with stage IIC and stage III GCT are treated with chemotherapy.
d. Inguinal orchiectomy followed by retroperitoneal radiation therapy cures approximately 98% of patients with stage I seminoma.
e. Bleomycin, etoposide and cisplatin ( BEP regimen ) are the three drugs which are usually used in the chemotherapy of testicular cancer .

answer a , is false because stage IIC seminoma is treated with chemotherapy and not radiation therapy . when the involved lymph nodes greatest diameter is greater than 5 cms then it is stage IIC GCT .