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  #1  
Old 12-20-2012
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Arrow A 28-year-old man with seminoma

A 28-year-old man presents complaining of heaviness in his testicle for 2 weeks. He states that he feels as though his testicle is enlarged. The man has a temperature of 37.2°C (98.9°F), a heart rate of 60/min, and a blood pressure of 115/70 mm Hg. He has a normal abdominal examination with no palpable masses. The right testicle is noticeably larger than the left testicle. There are no discrete nodules. Testicular ultrasound is performed, followed by an orchiectomy. He is found to have a seminoma and a retroperitoneal lymph node that is enlarged at 1.8 cm. He is given a diagnosis of stage IIA testicular seminoma (T2N1M0). What additional treatment is needed?

(A) Contralateral orchiectomy
(B) Platinum-based chemotherapy and bilateral orchiectomy
(C) Prophylactic mediastinal radiation
(D) Retroperitoneal lymph node dissection
(E) Retroperitoneal radiation
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Old 12-20-2012
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E) Retroperitoneal radiation
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Radiation therapy
Quote:
Radiation therapy: 35-40Gy is administered to the infradiaphragmatic area, including the para-aortic and ipsilateral iliac lymph nodes. Mediastinal radiation is not recommended.
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Old 12-21-2012
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Stage IIA seminomas: After surgery to remove the testicle (radical inguinal orchiectomy), these cancers are treated with radiation to the retroperitoneal lymph nodes. Usually higher doses of radiation are given for stage II seminomas than for stage I seminomas. If radiation can't be given for some reason, chemo may be used instead.

Stage IIB seminomas: All men will have radical inguinal orchiectomy to remove the testicle with the tumor. Treatment after surgery depends on the size of the retroperitoneal lymph nodes.

If none of the lymph nodes are larger than 3 cm across, they are treated with radiation. (If radiation can't be given for some reason, chemo may be used instead.)
If any of the lymph nodes are more than 3 cm across, though, chemo may be given instead. Either 4 cycles of EP (etoposide and cisplatin) or 3 cycles of BEP (bleomycin, etoposide, and cisplatin) may be used.
Stage IIc seminomas: These cancers are treated with radical inguinal orchiectomy, followed by 3 or 4 cycles of chemo with either EP or BEP. Radiotherapy is generally not used for stage IIc seminoma.

Stage II non-seminomas: Treatment for these tumors depends on the tumor markers and the retroperitoneal lymph nodes. All men will have radical inguinal orchiectomy to remove the testicle with the tumor. After surgery, there are 2 main options:

Retroperitoneal lymph node dissection (RPLND): This may be followed by further treatment with chemo if the lymph nodes have cancer in them. Chemo is usually given for 2 cycles.
Chemotherapy: Sometimes the doctor will recommend that the patient go straight to chemo (without doing the RPLND surgery). This is more likely to happen if the retroperitoneal lymph nodes are very large on the CT scan or if the tumor marker levels (HCG and/or AFP) are high even after the testicle with the tumor is removed. The chemo is usually given for 3 or 4 cycles.
After chemo, a CT scan is repeated to see if the retroperitoneal lymph nodes are still enlarged. If they are, they are removed by RPLND.

Stage III germ cell tumors

Both stage III seminomas and non-seminomas are treated with orchiectomy followed by chemo with a combination of drugs. The main regimens are the same as those used for stage II testicular cancers (usually BEP or EP) but at least 3 cycles of BEP or 4 cycles of EP are typically given. Patients with poor prognosis non-seminomas may receive 4 cycles of BEP. This treatment produces a cure in over 70% of cases.
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Old 12-23-2012
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well retroperitoneal radiation is the answer.
giving mediastinal radiation will cause radiation induced cardiomyopathy and fibrosis in severe cases.
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Old 12-25-2012
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Correct Answer

Yes The correct answer is (E) Retroperitoneal radiation. Thanks ts1234
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