202 Chapter 9 ■ PRACTICAL APPLICATIONS
Chapter Nine
PRACTICAL APPLICATIONS
Name: ______________________________
A. Case Report
A 22-year-old male presents with a scrotal mass that does not transilluminate. An orchiectomy
reveals embryonal carcinoma with teratoma. Chest x-rays and lung tomograms are normal. Serum
AFP (alpha-fetoprotein, a protein secreted by tumor cells. is elevated. Abdominal CT scan reveals
minimal retroperitoneal lymphadenopathy. Retroperitoneal lymphadenectomy indicates 4 of 42
nodes positive for embryonal carcinoma.
Six months after the node dissection the patient remains asymptomatic but his chest x-ray reveals
pulmonary metastases. AFP is slightly elevated. Chemotherapy (cisplatin, vinblastine, and bleomycin) is
given over 12 weeks. One month after completion of chemotherapy a thoracotomy is done and residual
lung lesions are removed. He remains free of disease 32 months after the start of chemotherapy.
1. What is the diagnosis for this
patient? ……………………………………….
A. Prostate cancer
B. Testicular cancer
C. Benign prostatic hyperplasia
D. Lung cancer
2. What was the primary method
of treatment? ………………………………..
A. Chemotherapy
B. Radiation therapy
C. Surgical removal of the prostate gland
D. Surgical removal of a testis
3. What other surgical procedure was
done to stage the patient’s condition? ……
A. Removal of tumor from the lung
B. Chest x-ray
C. Removal of pelvic lymph nodes
D. Removal of lymph nodes behind the
membrane lining the abdominal cavity
4. What treatment was initially given for
spread of the tumor to the lungs? …….
A. Drug treatment with AFP
B. Thoracotomy
C. Chemotherapy
D. Retroperitoneal lymphadenectomy
B. Chart Note
History: The patient is a 55-year-old male with adenocarcinoma of the prostate. He had a TURP
1 year ago for presumed prostatic hyperplasia, but tissue fragments examined by a pathologist
revealed a poorly differentiated adenocarcinoma. He received local irradiation to the prostate;
however, PSA levels increased to 10 (normal is less than 4). A bone scan showed bony metastases.
Bilateral orchiectomy was advised, but refused. Alternative hormonal treatment with Lupron and
flutamide to decrease testosterone production will be offered.
1. What is the patient’s diagnosis? ……….
A. Prostate cancer
B. Bone cancer
C. Testicular cancer
D. BPH
2. What procedure revealed the
diagnosis? ……………………………………
A. Irradiation
B. Removal of the testicles
C. Bone scan
D. Transurethral resection of the prostate
3. Poorly differentiated means: ……………
A. Cells are mature
B. Cells are very immature
C. Cells have metastasized
D. Cells are not malignant
4. What type of drug treatment was
offered to the patient? …………………….
A. Standard chemotherapy with cytotoxic
agents
B. Androgens
C. Antiandrogen drugs
D. PSA treatment