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T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 Collecting Cancer Data: Testis 2014-2015 NAACCR We b ina r Se rie s Ja nua ry 8, 2015 Q&A Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r c o nte nt thro ug h the Q&A

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SLIDE 1

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 1

Collecting Cancer Data: Testis

2014-2015 NAACCR We b ina r Se rie s Ja nua ry 8, 2015

Q&A

  • Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r

c o nte nt thro ug h the Q&A pa ne l. Re minde r:

  • I

f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils.

  • We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k.

T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b ina r.

2

F ABUL OUS PRIZE S

3

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SLIDE 2

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 2 OVERVIEW

T e stis

COUNT S

  • E

stima te d ne w c a se s a nd de a ths fro m te stic ula r c a nc e r in the Unite d Sta te s in 2014:

  • Ne w c a se s: 8,820
  • De a ths: 380
  • Mo st c o mmo n so lid tumo r ma lig na nc y a mo ng

me n b e twe e n 15 a nd 34 ye a rs o f a g e .

  • Wo rld wide inc ide nc e ha s do ub le d in la st 40

ye a rs. F IVE

  • YE

AR RE L AT IVE * SURVIVAL RAT E S (% ) BY ST AGE AT DIAGNOSIS, 2003- 2009

L

  • c a l

Re g iona l Dista nt All Sta g e s

T e stis 99 96 74 95

6

*Ra te s a re a djuste d fo r no rma l life e xpe c ta nc y a nd a re b a se d o n c a se s dia g no se d in the SE E R 18 a re a s fro m 2003-2009, a ll fo llo we d thro ug h 2010. So urc e : Ho wla de r N, No o ne AM, K ra pc ho M, e t a l. (e ds). SE E R Ca nc e r Sta tistic s Re vie w, 1975-2010, Na tio na l Ca nc e r I nstitute , Be the sda , MD http:/ / se e r.c a nc e r.g o v/ c sr/ 1975_2010/ , b a se d o n No ve mb e r 2012 SE E R da ta sub missio n, po ste d to the SE E R We b site , April 2013

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SLIDE 3

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 3 ANATOMY

T unic a Albugine a T unic a Vaginalis (Vas) Re te T e stis

http:/ / www.c a nc e r.ne t

RE GIONAL L YMPH NODE S

  • Inte ra o rto c a va l
  • Pa ra a o rtic
  • Pa ra c a va l
  • Pre a o rtic
  • Pre c a va l
  • Re tro a o rtic
  • Re tro c a va l

Re trope ritone al lymph Node s

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SLIDE 4

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 4

RE GIONAL L YMPH NODE S

  • L

e ft te stic le dra ins prima rily to the pa ra a o rtic lymph no de s

  • Rig ht te stic le dra ins

prima rily to the inte r a o rto c a va l lymph no de s

Re trope ritone al node s

L ung

http:/ / www.c a nc e r.ne t/ site s/ c a nc e r.ne

ICD O 3 SIT E S

ICD O 3 T e rm C62.0 Unde sc e nde d te stis C62.1 De sc e nde d te stis C62.9 T e stis, NOS

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SLIDE 5

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 5

PAT HOL OGY

  • Ove r 95% o f te stic ula r c a nc e rs a re g e rm-c e ll

tumo rs

  • Se mino ma s 40%
  • No n Se mino ma 60%

13

GE RM CE L L T UMORS (GCT )

  • Se mino ma , NOS (9061)
  • Cla ssic (9061)
  • Ana pla stic (9062)
  • Spe rma to c ytic (9063)

GCT

  • No n-se mino ma
  • E

mb ryo na l c a rc ino ma (9070/ 3)

  • Ma lig na nt te ra to ma (9080/ 3)
  • T

e ra to c a rc ino ma (9081/ 3)

  • Mixe d e mb ryo na l c a rc ino ma a nd te ra to ma
  • Ma lig na nt te ra to ma , undiffe re ntia te d (9082/ 3)
  • Ma lig na nt te ra to ma , inte rme dia te (9083/ 3)
  • E

xtra -e mb ryo nic e le me nts

  • Cho rio c a rc ino ma
  • Yo lk sa c tumo r
  • No n-se mino ma is the mo re c linic ally aggre ssive tumo r
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SLIDE 6

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 6

MAT URE T E RAT OMA

  • I

CD O 3 histo lo g y fo r Ma ture T e ra to ma is 9080/ 0

  • A ma ture te ra to ma o c c urring in a dults (po st

pub e rty) is re po rta b le .

  • Co de to 9080/ 3
  • A ma ture te ra to ma (no s) o c c urring in c hild is

no t re po rta b le .

  • Co de to 9080/ 0
  • If physic ia n indic a te s the ma ture te ra to ma is

ma lig na nt the c a se is re po rta b le a nd sho uld b e c o de d to 9080/ 3

MIXE D CE L L

  • Se mino ma mixe d with no n-se mino ma sho uld

b e c o nside re d no n-se mino ma fo r tre a tme nt de c isio ns

NON- GE RM CE L L T UMORS

  • L

e ydig c e ll tumo r (8650/ 3)

  • Se rto li c e ll tumo r (8640/ 3)
  • L

ympho ma

  • Rha b do mysa rc o ma
  • Me la no ma
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SLIDE 7

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 7

SE RUM T UMOR MARKE RS

  • Use d to he lp dia g no se dise a se
  • Sta g e dise a se
  • De te rmine pro g no sis
  • Mo nito r fo r re la pse
  • L

e ve ls sho uld b e de te rmine d

  • Be fo re o rc hie c to my
  • Afte r o rc hie c to my
  • T

hro ug ho ut fo llo w-up

19

AL PHA- F E T OPROT E IN (AF P)

  • E

le va te d AF P va lue s a re fo und in no n- se mino ma to us ma lig na nc ie s a nd mixe d tumo rs

  • f the te stis.
  • Ra re ly o c c ur in pure se mino ma s
  • Ca n b e use d to he lp ide ntify spe c ific c e ll type s

a nd to mo nito r re spo nse to tre a tme nt.

  • Ha lf life is 5-7 da ys

BE T A- HUMAN CHORIONIC GONADOT ROPIN (BE T A- HCG)

  • I

nc re a se d le ve ls o f Be ta -HCG a re typic a lly pre se nt in b o th se mino ma s a nd no n- se mino ma s.

  • E

le va te d le ve ls a fte r re missio n indic a te s a po te ntia l re la pse .

  • Ha lf life is 1-3 da ys

21

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SLIDE 8

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 8

L ACT AT E DE HYDROGE NASE (L DH)

  • An e le va te d L

DH ha s a pro g no stic va lue in me n with a dva nc e d te stic ula r c a nc e r.

  • T

he L DH ma y re fle c t the g ro wth ra te a nd tumo r b urde n in me n with a dva nc e d dise a se .

  • Inc re a se d L

DH ha s b e e n re po rte d in a ppro xima te ly 80% o f a dva nc e d se mino ma s a nd 60% o f no n- se mino ma s.

  • Ha lf life o f L

DH is 1-3 da ys

22

Pro g no stic fe a ture s a nd ma rke rs fo r te stic ula r c a nc e r ma na g e me nt http:/ / www.nc b i.nlm.nih.g o v/ p mc / a rtic le s/ PMC2878444/

L YMPH VASCUL AR INVASION (L VI)

  • I

ndic a te s the pre se nc e o r a b se nc e o f tumo r c e lls in lympha tic c ha nne ls (no t lymph no de s)

  • r b lo o d ve sse ls within the prima ry tumo r a s

no te d mic ro sc o pic a lly b y the pa tho lo g ist.

  • Use d to de te rmine the T

va lue

  • Ma y b e the diffe re nc e b e twe e n a T

1 a nd T 2

  • L

ymphva sc ula r inva sio n is a stro ng risk fa c to r fo r re c urre nc e .

MULTIPLE PRIMARY AND HISTOLOGY RULES

Othe r Rule s

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SLIDE 9

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 9

HIST OL OGY RUL E S

  • Rule H11
  • Co de the histo lo g y whe n o nly o ne histo lo g ic type is

ide ntifie d

  • Rule H13
  • Co de the mo st spe c ific histo lo g ic te rm

HIST OL OGY RUL E S

  • Rule H16
  • Co de the a ppro pria te c o mb ina tio n/ mixe d c o de

(T a b le 2) whe n the re a re multiple spe c ific histo lo g ie s

  • r whe n the re is a no n-spe c ific histo lo g y with

multiple spe c ific histo lo g ie s

  • Rule H17
  • Co de the histo lo g y with the nume ric a lly hig he r ICD-

O-3 c o de .

MUL T IPL E PRIMARY AND HIST OL OGY RUL E S

Re quire d Histology Combine d With Combine d T e r m Code

T e ra to ma E mb ryo na l Ca rc ino ma T e ra to c a rc ino ma 9081 T e ra to ma a nd o ne

  • r mo re histo lo g ie s

in c o lumn 2 Se mino ma Yo lk sa c tumo r Mixe d g e rm c e ll tumo r 9085 Cho rio c a rc ino ma T e ra to ma Se mino ma E mb ryo na l Cho rio c a rc ino ma with o the r g e rm c e ll e le me nts 9101

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SLIDE 10

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 10

POP QUIZ

  • Wha t histo lo g y wo uld b e a ssig ne d to a sing le

tumo r c o nsisting o f…

  • Se mino ma a nd e mb ryo na l c a rc ino ma
  • Ma lig na nt te ra to ma a nd e mb ryo na l c a rc ino ma
  • Se mino ma , yo lk sa c tumo r, a nd te ra to ma

QUESTIONS?

ST AGING: T E ST IS

30

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SLIDE 11

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 11

T E ST IS: CHAPT E R 42

AJCC Ca nc e r Sta g e

31 32 33

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SLIDE 12

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 12

34

AJCC CANCE R ST AGE : T E ST IS

  • I

CD-O-3 T

  • po g ra phy Co de s
  • C62.0, C62.1, C62.9
  • I

CD-O-3 Histo lo g y Co de Ra ng e s

  • 8000-8576
  • 8590-8670
  • 8940-8950
  • 8980-8981
  • 9060-9090
  • 9100-9105

35

AJCC CANCE R ST AGE : T E ST IS CL ASSIF ICAT ION

  • Clinic a l sta g ing
  • Clinic a l e xa m a nd histo lo g ic a sse ssme nt
  • Ra dio g ra phic a sse ssme nt o f c he st, a b do me n, &

pe lvis to de te rmine N & M sta tus

36

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SLIDE 13

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 13

AJCC CANCE R ST AGE : T E ST IS CL ASSIF ICAT ION

  • Pa tho lo g ic sta g ing
  • Histo lo g ic e va lua tio n o f o rc hie c to my spe c ime n to

de te rmine pT

  • Asse ssme nt o f pre se nc e o r a b se nc e o f lymph-

va sc ula r inva sio n (L VI)

  • Spe c ime n fro m a de fine d no de -b e a ring a re a to

c la ssify pN

  • Re c o rd dia me te r o f la rg e st invo lve d no de , numb e r
  • f no de s invo lve d, & e xtra no da l e xte nsio n if pre se nt
  • Po st-o rc hie c to my se rum tumo r ma rke rs

37

AJCC CANCE R ST AGE : T E ST IS

  • T

Ca te g o ry

  • E

xte nt o f prima ry tumo r fo r T NM c la ssifie d b y ra dic a l

  • rc hie c to my
  • E

xc e pt fo r pT is a nd pT 4

  • T

X ma y b e use d fo r o the r c a te g o rie s in a b se nc e o f

  • rc hie c to my

38

AJCC CANCE R ST AGE : T E ST IS

  • T

Ca te g o ry

  • T

X: Prima ry tumo r c a nno t b e a sse sse d

  • T

0: No e vide nc e o f prima ry tumo r

  • T

is: Intra tub ula r g e rm c e ll ne o pla sia (c a rc ino ma in situ)

  • T

1: T umo r limite d to the te stis & e pididymis witho ut va sc ula r/ lympha tic inva sio n; tumo r ma y inva de into the tunic a a lb ug ine a b ut no t the tunic a va g ina lis

39

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SLIDE 14

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 14

AJCC CANCE R ST AGE : T E ST IS

  • T

Ca te g o ry

  • T

2: T umo r limite d to the te stis & e pididymis with va sc ula r/ lympha tic inva sio n, o r tumo r e xte nding thro ug h the tunic a a lb ug ine a with invo lve me nt o f the tunic a va g ina lis

  • T

3: T umo r inva de s the spe rma tic c o rd with o r witho ut va sc ula r/ lympha tic inva sio n

  • T

4: T umo r inva de s the sc ro tum with o r witho ut va sc ula r/ lympha tic inva sio n

40

AJCC CANCE R ST AGE : T E ST IS

  • N Ca te g o ry: Clinic al
  • NX: Re g io na l lymph no de s c a nno t b e a sse sse d
  • N0: No re g io na l lymph no de me ta sta sis
  • N1: Me ta sta sis with a lymph no de ma ss 2 c m o r le ss in

g re a te st dime nsio n; o r multiple lymph no de s, no ne mo re tha n 2 c m in g re a te st dime nsio n

  • N2: Me ta sta sis with a lymph no de ma ss mo re tha n 2 c m

b ut no t mo re tha n 5 c m in g re a te st dime nsio n; o r multiple lymph no de s, a ny o ne ma ss g re a te r tha n 2 c m b ut no t mo re tha n 5 c m in g re a te st dime nsio n

  • N3: Me ta sta sis with a lymph no de ma ss mo re tha n 5 c m

in g re a te st dime nsio n

41

AJCC CANCE R ST AGE : T E ST IS

  • N Ca te g o ry: Patho lo gic (pN)
  • NX: Re g io na l lymph no de s c a nno t b e a sse sse d
  • N0: No re g io na l lymph no de me ta sta sis
  • N1: Me ta sta sis with a lymph no de ma ss 2 c m o r le ss in

g re a te st dime nsio n a nd le ss tha n o r e q ua l to 5 no de s po sitive , no ne mo re tha n 2 c m in g re a te st dime nsio n

  • N2: Me ta sta sis with a lymph no de ma ss mo re tha n 2 c m

b ut no t mo re tha n 5 c m in g re a te st dime nsio n; o r mo re tha n 5 no de s po sitive , no ne mo re tha n 5 c m; o r e vide nc e o f e xtra no da l e xte nsio n o f tumo r

  • N3: Me ta sta sis with a lymph no de ma ss mo re tha n 5 c m

in g re a te st dime nsio n

42

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SLIDE 15

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 15

AJCC CANCE R ST AGE : T E ST IS

  • M Ca te g o ry
  • M0: No dista nt me ta sta sis
  • M1: Dista nt me ta sta sis
  • M1a : No n-re g io na l no da l o r pulmo na ry me ta sta sis
  • M1b : Dista nt me ta sta sis o the r tha n to no n-re g io na l

lymph no de s a nd lung

43

AJCC CANCE R ST AGE : T E ST IS

  • Se rum tumo r ma rke rs
  • SX: Ma rke r studie s no t a va ila b le o r no t pe rfo rme d
  • S0: Ma rke r study le ve ls within no rma l limits
  • S1: L

DH < 1.5 X N* and hCG (mlu/ ml) < 5,000 and AF P (ng / ml) < 1,000

  • S2: L

DH 1.5-10 X N o rhCG (mlu/ ml) 5,000-50,000 o r AF P (ng / ml) 1,000-10,000

  • S3: L

DH > 10 X N o rhCG (mlu/ ml) > 50,000 o rAF P (ng / ml) > 10,000

44

* N = uppe r limit o f no rma l

AJCC CANCE R ST AGE : T E ST IS

Group T N M S

Sta g e 0 pT is N0 M0 S0 Sta g e I pT 1-4 N0 M0 SX Sta g e I A pT 1 N0 M0 S0 Sta g e I B pT 2 pT 3 pT 4 N0 N0 N0 M0 M0 M0 S0 S0 S0 Sta g e I S Any pT / T x N0 M0 S1-3

45

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SLIDE 16

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 16

AJCC CANCE R ST AGE : T E ST IS

Group T N M S

Sta g e I I Any pT / T x N1-3 M0 SX Sta g e I I A Any pT / T x Any pT / T x N1 N1 M0 M0 S0 S1 Sta g e I I B Any pT / T x Any pT / T x N2 N2 M0 M0 S0 S1 Sta g e I I C Any pT / T x Any pT / T x N3 N3 M0 M0 S0 S1

46

AJCC CANCE R ST AGE : T E ST IS

Group T N M S

Sta g e I I I Any pT / T x Any N M1 SX Sta g e I I I A Any pT / T x Any pT / T x Any N Any N M1a M1a S0 S1 Sta g e I I I B Any pT / T x Any pT / T x N1-3 Any N M0 M1a S2 S2 Sta g e I I I C Any pT / T x Any pT / T x Any pT / T x N1-3 Any N Any N M0 M1a M1b S3 S3 Any S

47

POP QUIZ

  • Pre -o pe ra tive ima g ing : E

nla rg e d le ft te stis; no lympha de no pa thy; no dista nt me ta sta sis

  • Pre -o pe ra tive la b s: AF

P within no rma l limits; L DH within no rma l limits; hCG e le va te d

  • L

e ft ra dic a l o rc hie c to my: 8 c m te stic ula r tumo r, se mino ma , c o nfine d to the te stis; lymph va sc ula r inva sio n pre se nt

  • Po st-o pe ra tive la b s: AF

P, L DH, a nd hCG within no rma l limits

48

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SLIDE 17

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 17

POP QUIZ

  • Wha t is the AJCC c linic a l sta g e ?
  • Wha t is the AJCC pa tho lo g ic sta g e ?

49

T E ST IS

Summa ry Sta g e 2000 http:/ / se e r.c a nc e r.g o v/ to o ls/ ssm/

50

SUMMARY ST AGE 2000: T E ST IS

  • 0 I

n situ

  • No ninva sive ; intra e pithe lia l
  • 1 L
  • c a lize d o nly
  • Inva sive tumo r with/ witho ut va sc ula r inva sio n limite d

to : b o dy o f te stis; re te te stis; tunic a a lb ug ine a

  • Surfa c e impla nts
  • T

unic a NOS

  • T

unic a va g ina lis invo lve d

  • L
  • c a lize d NOS

51

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SLIDE 18

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 18

SUMMARY ST AGE 2000: T E ST IS

  • 2 Re g io na l b y dire c t e xte nsio n o nly
  • E

xte nsio n to : da rto s musc le , ipsila te ra l; e pididymis with/ witho ut va sc ula r/ lympha tic inva sio n; sc ro tum, ipsila te ra l; spe rma tic c o rd, ipsila te ra l; va s de fe re ns

  • 3 Re g io na l lymph no de (s) invo lve d o nly
  • Co ntra la te ra l o r b ila te ra l no de s
  • Ao rtic , e xte rna l ilia c , pe ric a va l, pe lvic , re tro pe rito ne a l,

spe rma tic ve in

  • Re g io na l lymph no de s NOS

52

SUMMARY ST AGE 2000: T E ST IS

  • 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

  • Co de s 2 + 3
  • 5 Re g io na l NOS

53

SUMMARY ST AGE 2000: T E ST IS

  • 7 Dista nt site (s)/ lymph no de (s) invo lve d
  • Dista nt lymph no de (s)
  • I

ng uina l; o the r dista nt lymph no de (s)

  • E

xte nsio n to

  • Co ntra la te ra l sc ro tum; pe nis
  • Ulc e ra tio n o f sc ro tum
  • F

urthe r c o ntig uo us e xte nsio n

  • Me ta sta sis
  • Adre na l g la nd; kidne y; re tro pe rito ne um; te stis, b ila te ra l
  • 9 Unkno wn if e xte nsio n o r me ta sta sis

54

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SLIDE 19

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 19

POP QUIZ

  • Pre -o pe ra tive ima g ing : E

nla rg e d le ft te stis; no lympha de no pa thy; no dista nt me ta sta sis

  • Pre -o pe ra tive la b s: AF

P within no rma l limits; L DH within no rma l limits; hCG e le va te d

  • L

e ft ra dic a l o rc hie c to my: 8 c m te stic ula r tumo r, se mino ma , c o nfine d to the te stis; lymph va sc ula r inva sio n pre se nt

  • Po st-o pe ra tive la b s: AF

P, L DH, a nd hCG within no rma l limits

55

POP QUIZ

  • Wha t is the Summa ry Sta g e 2000?

a . 1 L

  • c a lize d o nly

b . 2 Re g io na l b y dire c t e xte nsio n o nly c . 3 Re g io na l lymph no de (s) invo lve d o nly

  • d. 4 Re g io na l b y BOT

H dire c t e xte nsio n AND re g io na l lymph no de (s) invo lve d

e . 5 Re g io na l NOS f.

7 Dista nt site (s)/ lymph no de (s) invo lve d

56

T E ST IS

Co lla b o ra tive Sta g e Da ta Co lle c tio n Syste m (CS) V0205

57

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SLIDE 20

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 20

CS E XT E NSION: T E ST IS

  • Co de 000: I

n situ, intra e pithe lia l, no ninva sive ; intra tub ula r g e rm c e ll ne o pla sia

  • Co de s 160-330 & 460-550
  • T

c a te g o ry b a se d o n CS E xte nsio n, SSF 4 (Ra dic a l Orc hie c to my Pe rfo rme d), & L ymph-va sc ula r Inva sio n (L VI)

  • De rive s T

1, T 2, T 3

  • Co de s 600-810
  • Sc ro ta l invo lve me nt

58

CS L YMPH NODE S: T E ST IS

  • Co de 100: Ao rtic ; re tro pe rito ne a l; spe rma tic ve in
  • Co de 200: Pe ric a va l
  • Co de 300: Pe lvic , e xte rna l ilia c WI

T H pre vio us sc ro ta l o r ing uina l surg e ry

  • Co de 350: 300 + 200
  • Co de 400: I

ng uina l WI T H pre vio us sc ro ta l o r ing uina l surg e ry

  • Co de s 100-500: N Ca te g o ry b a se d o n SSF

5 (Size o f Me ta sta sis in L ymph No de s), Re g io na l No de s Po sitive , & CS L ymph No de s E va l

59

CS ME T S AT DX: T E ST IS

  • Co de 11: Pe lvic , e xte rna l ilia c WI

T HOUT pre vio us sc ro ta l o r ing uina l surg e ry

  • Co de 12: I

ng uina l WI T HOUT pre vio us sc ro ta l o r ing uina l surg e ry

  • Co de 13: Spe c ifie d dista nt lymph no de s o the r tha n c o de s 11
  • r 12; dista nt lymph no de (s) NOS
  • Co de 20: Dista nt me ta sta sis to lung
  • Co de 25: 20 + (11, 12, o r 13)
  • Co de 40: Me ta sta sis to o the r dista nt site s with o r witho ut

me ta sta sis to lung a nd/ o r dista nt lymph no de (s); c a rc ino ma to sis

  • Co de 60: Dista nt me ta sta sis NOS

60

slide-21
SLIDE 21

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 21

POP QUIZ

  • Pre -o pe ra tive ima g ing : E

nla rg e d le ft te stis; no lympha de no pa thy; no dista nt me ta sta sis

  • Pre -o pe ra tive la b s: AF

P within no rma l limits; L DH within no rma l limits; hCG e le va te d

  • L

e ft ra dic a l o rc hie c to my: 8 c m te stic ula r tumo r, se mino ma , c o nfine d to the te stis; lymph va sc ula r inva sio n pre se nt

  • Po st-o pe ra tive la b s: AF

P, L DH, a nd hCG within no rma l limits

61

POP QUIZ

  • Wha t is the c o de fo r CS E

xte nsio n?

a . 160: Bo dy o f te stis; re te te stis; tunic a a lb ug ine a b . 200: T

unic a va g ina lis invo lve d; surfa c e impla nts

c . 300: L

  • c a lize d NOS
  • d. 999: Unkno wn

62

POP QUIZ

  • Wha t is the c o de fo r CS L

ymph No de s?

a . 000: No re g io na l lymph no de invo lve me nt b . 500: Re g io na l lymph no de s NOS c . 800: L

ymph no de s NOS

  • d. 999: Unkno wn

63

slide-22
SLIDE 22

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 22

POP QUIZ

  • Wha t is the c o de fo r CS Me ts a t DX?

a . 00: No dista nt me ta sta sis b . 11: Dista nt lymph no de s witho ut pre vio us sc ro ta l o r

ing uina l surg e ry

c . 60: Dista nt me ta sta sis NOS

  • d. 99: Unkno wn

64

SSF 4: RADICAL ORCHIE CT OMY PE RF ORME D

  • T

c a te g o ry b a se d o n CS E xte nsio n, SSF 4, & L ymph-va sc ula r I nva sio n (L VI )

  • Do c ume nts if ra dic a l o rc hie c to my wa s

pe rfo rme d (010), no t pe rfo rme d (000), o r unkno wn (999)

65

SSF 5: SIZE OF ME T AST ASIS IN L YMPH NODE S

  • N Ca te g o ry b a se d o n SSF

5, Re g io na l No de s Po sitive , & CS L ymph No de s E va l

  • Co de s inc o rpo ra te size ra ng e fo r me ta sta sis in

re g io na l lymph no de ma ss a nd a b se nc e o r pre se nc e o f e xtra no da l e xte nsio n

  • I

f e xtra no da l e xte nsio n is no t me ntio ne d in pa th, a ssume it is no t pre se nt

66

slide-23
SLIDE 23

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 23

PRE

  • ORCHIE

CT OMY SE RUM T UMOR MARKE RS

  • SSF

6: Pre -Orc hie c to my Alpha F e to pro te in (AF P) L a b Va lue

  • SSF

7: Pre -Orc hie c to my Alpha F e to pro te in (AF P) Ra ng e

  • SSF

8: Pre -Orc hie c to my Huma n Cho rio nic Go na do tro pin (hCG) L a b Va lue

  • SSF

9: Pre -Orc hie c to my Huma n Cho rio nic Go na do tro pin (hCG) Ra ng e

  • SSF

10: Pre -Orc hie c to my L a c ta te De hydro g e na se (L DH) Ra ng e

67

PRE

  • ORCHIE

CT OMY L AB VAL UE

  • Assig n c o de 000 fo r e xa c tly 0.0
  • Use c o de 995 if pa tie nt is tre a te d prio r to
  • rc hie c to my a nd re c o rd la b va lue in po st-
  • rc hie c to my SSF
  • Use c o de 996 if no o rc hie c to my; re c o rd la b

va lue in po st-o rc hie c to my SSF

  • Use c o de 997 if te st do ne b ut a c tua l la b va lue

no t sta te d

68

PRE

  • ORCHIE

CT OMY RANGE

  • Use c o de s 991-993 if te st una va ila b le b ut

physic ia n sta te me nt o f re sult is a va ila b le

  • Use c o de 995 if pa tie nt is tre a te d prio r to
  • rc hie c to my a nd re c o rd ra ng e in po st-
  • rc hie c to my SSF
  • Use c o de 996 if no o rc hie c to my; re c o rd ra ng e

in po st-o rc hie c to my SSF

69

slide-24
SLIDE 24

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 24

POST

  • ORCHIE

CT OMY SE RUM T UMOR MARKE RS

  • SSF

13: Po st-Orc hie c to my Alpha F e to pro te in (AF P) Ra ng e

  • SSF

15: Po st-Orc hie c to my Huma n Cho rio nic Go na do tro pin (hCG) Ra ng e

  • SSF

16: Po st-Orc hie c to my L a c ta te De hydro g e na se (L DH) Ra ng e

70

POST

  • ORCHIE

CT OMY RANGE

  • I

f initia l po st-o rc hie c to my te st re ma ins e le va te d, re vie w sub se q ue nt te sts until pla te a u o c c urs a nd c o de tha t te st

  • Use c o de 990 if po st-o rc hie c to my te st is unkno wn

b ut pre -o rc hie c to my te st wa s no rma l

  • Use c o de s 991-993 if po st-o rc hie c to my te st is

una va ila b le b ut physic ia n’ s sta te me nt o f re sult is do c ume nte d

  • I

f pa tie nt is tre a te d prio r to o rc hie c to my o r

  • rc hie c to my is no t pe rfo rme d, re c o rd initia l la b

va lue in po st-o rc hie c to my SSF

71

POP QUIZ

  • Pre -o pe ra tive ima g ing : E

nla rg e d le ft te stis; no lympha de no pa thy; no dista nt me ta sta sis

  • Pre -o pe ra tive la b s: AF

P within no rma l limits; L DH within no rma l limits; hCG e le va te d

  • L

e ft ra dic a l o rc hie c to my: 8 c m te stic ula r tumo r, se mino ma , c o nfine d to the te stis; lymph va sc ula r inva sio n pre se nt

  • Po st-o pe ra tive la b s: AF

P, L DH, a nd hCG within no rma l limits

72

slide-25
SLIDE 25

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 25

POP QUIZ

  • Wha t is the c o de fo r SSF

4?

a . 000: Ra dic a l o rc hie c to my no t pe rfo rme d b . 010: Ra dic a l o rc hie c to my pe rfo rme d c . 988: No t a pplic a b le

  • d. 999: Unkno wn

73

POP QUIZ

  • Wha t is the c o de fo r SSF

5?

a . 000: No lymph no de me ta sta sis b . 010: L

ymph no de me ta sta sis ma ss 2 c m o r le ss witho ut pa tho lo g ic e xtra no da l e xte nsio n

c . 020: L

ymph no de me ta sta sis ma ss mo re tha n 2 c m b ut no t mo re tha n 5 c m OR pa tho lo g ic e xtra no da l e xte nsio n

  • d. 030 L

ymph no de me ta sta sis ma ss mo re tha n 5 c m

74

POP QUIZ

  • Wha t is the c o de fo r

SSF 6?

a . 000: 0 ng / ml b . 997: T

e st o rde re d, re sults no t in c ha rt

c .

998: T e st no t do ne

d . 999: Unkno wn

  • Wha t is the c o de fo r

SSF 7?

a . 000: Within no rma l limits b . 010: Ra ng e 1 (S1) a b o ve

no rma l & le ss tha n 1,000 ng / ml

c .

992: Pre -o rc hie c to my AF P unkno wn b ut pre -

  • rc hie c to my se rum

tumo r ma rke rs NOS sta te d to b e no rma l

d . 997: T

e st o rde re d, re sults no t in c ha rt

75

slide-26
SLIDE 26

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 26

POP QUIZ

  • Wha t is the c o de fo r

SSF 8?

a . 000: mI

U/ ml

b . 997: T

e st o rde re d, re sults no t in c ha rt

c .

998: T e st no t do ne

d . 999: Unkno wn

  • Wha t is the c o de fo r

SSF 9?

a . 000: Within no rma l limits b . 991: Pre -o rc hie c to my

huma n c ho rio nic g o na do tro pin (hCG) sta te d to b e e le va te d

c .

992: Pre -o rc hie c to my hCG unkno wn b ut pre -

  • rc hie c to my se rum

tumo r ma rke rs NOS sta te d to b e no rma l

d . 997: T

e st o rde re d, re sults no t in c ha rt

76

POP QUIZ

  • Wha t is the c o de fo r SSF

10?

a . 000: Within no rma l limits b . 991: Pre -o rc hie c to my L

DH sta te d to b e e le va te d

c . 992: Pre -o rc hie c to my L

DH unkno wn b ut pre -

  • rc hie c to my se rum tumo r ma rke rs NOS sta te d to

b e no rma l

  • d. 997: T

e st o rde re d, re sults no t in c ha rt

77

POP QUIZ

  • Wha t is the c o de fo r SSF

13?

a . 000: Within no rma l limits b . 990: Po st-o rc hie c to my AF

P unkno wn b ut pre -

  • rc hie c to my AF

P wa s no rma l

c . 992: Po st-o rc hie c to my AF

P unkno wn b ut po st-

  • rc hie c to my se rum tumo r ma rke rs NOS sta te d to

b e no rma l

  • d. 999: Unkno wn

78

slide-27
SLIDE 27

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 27

POP QUIZ

  • Wha t is the c o de fo r SSF

15?

a . 000: Within no rma l limits b . 990: Po st-o rc hie c to my hCG unkno wn b ut pre -

  • rc hie c to my hCG wa s no rma l

c . 992: Po st-o rc hie c to my hCG unkno wn b ut po st-

  • rc hie c to my se rum tumo r ma rke rs NOS sta te d to

b e no rma l

  • d. 999: Unkno wn

79

TREATMENT

DIAGNOSIS

  • Physic ia l e xa m
  • Ultra so und (dia g no stic )
  • Othe r Ima g ing (sta g ing )
  • PE

T Sc a n fo r Se mino ma

  • T

umo r Ma rke rs

  • Bio psy no t usually do ne

81

slide-28
SLIDE 28

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 28

T RE AT ME NT

  • Mo re tha n 90% o f pa tie nts with g e rm c e ll

tumo rs a re c ure d.

  • T

ha t inc lude s 70-80% o f pa tie nts with a dva nc e d tumo rs who a re tre a te d with c he mo the ra py.

82

SURGE RY

  • 20 L
  • c a l o r pa rtia l e xc isio n
  • f te stic le
  • 30 E

xc isio n o f te stic le WIT HOUT c o rd

  • 40 E

xc isio n o f te stic le WIT H c o rd o r c o rd no t me ntio ne d (ra dic a l

  • rc hie c to my)
  • 80 Orc hie c to my, NOS

(unspe c ifie d whe the r pa rtia l o r to ta l te stic le re mo ve d)

Ca nc e r Re se a rc h UK

SURGE RY

  • 30 E

xc isio n o f te stic le , WI T HOUT c o rd

  • [SE

E R No te : Orc hie c to my no t inc luding spe rma tic c o rd]

  • 40 E

xc isio n o f te stic le WI T H c o rd o r c o rd no t me ntio ne d (ra dic a l o rc hie c to my)

  • [SE

E R No te : Orc hie c to my with o r witho ut spe rma tic c o rd]

  • 80 Orc hie c to my, NOS (unspe c ifie d whe the r

pa rtia l o r to ta l te stic le re mo ve d)

84

slide-29
SLIDE 29

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 29

SE RUM MARKE RS

  • Se rum ma rke rs sho uld b e a sse sse d b e fo re
  • rc hie c to my to e sta b lish a b e nc hma rk a nd

re pe a te d a fte r o rc hie c to my.

85

SE RUM MARKE RS

  • S0 - T

umo r ma rke r le ve ls within the re fe re nc e ra ng e

  • S1 - L

DH <1.5 time s the re fe re nc e ra ng e AND hCG le ve l < 5000 mI U/ mL AND AF P le ve l < 1000 ng / mL

  • S2 - L

DH le ve l 1.5-10 time s the re fe re nc e ra ng e OR hCG le ve l 5000-50,000 mI U/ mL OR AF P le ve l 1000- 10,000 ng / mL

  • S3 - L

DH le ve l > 10 time s the re fe re nc e ra ng e OR hCG le ve l > 50,000 mI U/ mL OR AF P le ve l >10,000 ng / mL

SE MINOMA

  • Se mino ma -Orc hie c to my fo llo we d b y
  • Sta g e s IA a nd IB
  • Pa tie nts with pT

1 o r pT 2 Ac tive surve illa nc e if a pplic a b le

  • Ra dio the ra py o r c he mo the ra py
  • Sta g e IS
  • Ra dia tio n
  • Sta g e I

I A a nd II B

  • Ra dia tio n
  • Che mo the ra py ma y b e a n a lte rna te tre a tme nt fo r so me II

B pa tie nts

  • Sta g e I

I C a nd II I

  • Sta nda rd c he mo the ra py
slide-30
SLIDE 30

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 30

RADIAT ION

  • Infra dia phra ma tic

b e a m ra dia tio n

  • Ma y inc lude pa ra -a o rtic

no de s a nd/ o r ipsila te ra l ilia c no de s

http:/ / www.c a nc e r.ne t/ site s/ c a nc e r.ne t

NON SE MINOMA

  • No n se mino ma -Orc hie c to my fo llo we d b y…
  • Sta g e IA
  • Surve illa nc e o r RPL

ND

  • Sta g e IB
  • RPL

ND o r Che mo the ra py

  • Sta g e IS
  • Che mo the ra py

CHE MOT HE RAPY

  • E

to po side

  • Cispla tin
  • Ble o myc in
  • Me sna
  • I

fo smfa mide

slide-31
SLIDE 31

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 31

NON SE MINOMA

  • No n se mino ma -Orc hie c to my fo llo we d b y…
  • Sta g e I

I A-de pe nds o n se rum ma rke rs

  • No rma l se rum ma rke rs-RPL

ND fo llo we d b y c he mo o r surve illa nc e

  • E

le va te d se rum ma rke rs-c he mo fo llo we d b y RPL ND o r surve illa nc e

L YMPH NODE DISSE CT ION

  • Re tro pe rito ne a l lymph no de

disse c tio n (RPL ND)

http:/ / www.c a nc e r.ne t/ site s/ c a nc e r.ne t

NON SE MINOMA

  • No n se mino ma -Orc hie c to my fo llo we d b y…
  • Sta g e I

I B-de pe nds o n ima g ing a nd se rum ma rke rs

  • Ne g a tive se rum ma rke rs me ta sta sis limite d to re tro pe rito ne a l lymph

no de s tre a tme nt is simila r to 2A o r c he mo fo llo we d b y RPL ND

  • I

f e le va te d se rum ma rke rs a nd me ta sta sis b e yo nd the re tro pe rito ne a l lympha tic s, the n RPL ND no t re c o mme nde d. Che mo the ra py o nly.

  • Sta g e I

I C a nd I I I A

  • Che mo the ra py o nly
slide-32
SLIDE 32

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 32

NON SE MINOMA- ADVANCE D ST AGE

  • No n se mino ma -Orc hie c to my fo llo we d b y…
  • Sta g e I

I I B (inte rme dia te risk)-Che mo the ra py

  • Sta g e I

I I C (po o r risk)-Che mo the ra py

QUESTIONS?

POP QUIZ

  • Wha t is the c o de fo r SSF

16?

a . 000: Within no rma l limits b . 990: Po st-o rc hie c to my L

DH unkno wn b ut pre -

  • rc hie c to my L

DH wa s no rma l

c . 992: Po st-o rc hie c to my L

DH unkno wn b ut po st-

  • rc hie c to my se rum tumo r ma rke rs NOS sta te d to

b e no rma l

  • d. 999: Unkno wn

96

slide-33
SLIDE 33

T e stic ula r Ma lig na nc ie s 2015 1/ 8/ 15 NAAC CR 2014-2015 We b ina r Se rie s 33

COMING UP…

  • Co lle c ting Ca nc e r Da ta : Ute rus
  • 2/ 5/ 15
  • Ab stra c ting & Co ding Bo o t Ca mp
  • 3/ 5/ 15

97

AND T HE WINNE RS ARE … ..

98

CE CE RT IF ICAT E QUIZ/ SURVE Y

  • Phra se
  • L

ink

http:/ / www.surve yg izmo .c o m/ s3/ 1946545/ T e ste s-2015

99