Testicular cancer is the most common solid tumor in men between the ages of 20 and 35 years. There are three modal peaks: infancy, ages 25 to 40, and about age 60. A solid testicular mass in a man aged 50 or greater is usually a lymphoma. An estimated 6000 new cases and 350 deaths due to testicle cancer occured in the United States in 1995. The lifetime probability of developing a GCT is approximately 0.2% for an American Caucasian male. The incidence of testis cancer varies significantly according to geographic area. The reported incidence is highest in Scandinavia, Switzerland, Germany, and New Zealand; intermediate in the United States and Great Britain; and lowest in Africa and Asia. The worldwide incidence of testis GCT has more than doubled in the past 40 years.
1. Testicular cancer
2. Inital presentation and management
Carcinoma in situ (CIS) (intratubular germ cell neoplasia) precedes invasive testicular GCT in virtually all cases of typical and anaplastic seminoma and all nonseminomatous histologies in the adult. CIS is frequently present in retroperitoneal presentations and is rarely, if ever, present in mediastinal presentations. It has not been described in spermatocytic seminoma and rarely in tumors arising in prepubertal patients.
4. Nonseminomatous Germ Cell Tumors
5. Management of clinical stage 1 disease
Antegrade ejaculation requires coordination of three separate events: (1) closure of the bladder neck, (2) seminal emission, and (3) ejaculation.
7. Observation. Chemotherapy
8. Managment of clinical stage II (low tumor burden)
Low tumor burden stage II seminoma includes all patients with retroperitoneal metastases measuring 5 cm or smaller in maximum transverse diameter. This encompasses both clinical stages IIA and IIB. Radiation therapy is the treatment of choice for most patients with these stages of disease.
9. Adjuvant Chemotherapy
This year there will be almost 180,000 cases of prostate cancer diagnosed, and 37,000 deaths from the disease. There has been a very interesting pattern of incidence of prostate cancer in the United States over the past 30 years, which is illustrated by this slide, in the African-American population which is the top curve and in the Caucasian population in the United States. As you can see, over the past 20-30 years there was a steady but slow rise in the incidence of prostate cancer in these two populations, beginning in the later 1980’s, 1990’s, a rapid increase in incidence rates.
1. Prostate cancer
2. What’s the cause of prostate cancer?
3. Something about the epidemiology of prostate cancer
4. So what are the problems with PSA screening?
Well, the biggest problem I think is over-diagnosis. There are clearly people who have been diagnosed with prostate cancer that didn’t need to know, that would never had died of their disease if left untreated. What we debate is what the frequency of that phenomenon is.
5. This is the old clinical staging system. Prostate cancer
6. Now what about treatment for this disease?
7. A slightly different story with radiation therapy. Prostate cancer
A slightly different story with radiation therapy. Three RTOG studies looking at hormonal therapy followed by radiation, versus radiation therapy alone. I just want you to look at these two studies down here, comparing Zoladex or LHRH analog versus no concomitant radiation therapy.
8. Treatment of advanced prostate cancer
9. Off of a clinical trial
Ovarian carcinoma is the second most common malignancy of the female genital tract, at least in the United States. It accounts for about 25,200 cases a year, currently. The important figure is here; 14,500 deaths. This represents 62% of all deaths due to cancers of the female genital tract, and underlines the fact that ovarian carcinoma remains the only one of the three major gynecologic malignancies for which we do not have, as yet, an effective early diagnostic test. For that reason this lesion has, among the gynecologic malignancies, has been seen by more medical oncologists than any other gynecologic tumor.
1. Ovarian cancer
2. Now in terms of etiology
3. In terms of molecular biology
4. Prophylactic oophorectomy
5. Important prognostic factors
Important prognostic factors in ovarian carcinoma include age, and one thing to note about age; unlike most other solid tumors, older patients with ovarian carcinoma develop more aggressive disease. The older the patient the more aggressive the tumor is likely to be. The younger the patient, the less aggressive the tumor is likely to be.
6. FIGO staging system
7. At that same meeting at ASCO
8. Cisplatin or carboplatin
9. What about carboplatin
There have been three trials internationally looking at carboplatin. A British study comparing AUC6 to AUC12. A Danish study comparing AUC4 to AUC8 and an Austrian study comparing cisplatin to a combination of cisplatin plus carboplatin.
10. The two regimens that are acceptable
11. The patients who have grade II or grade III disease
12. The drugs that would be chosen as alternative therapy
13. A second trial that’s been reported is GOG protocol