138 - Testicular Lump

Question 0

What types of extra testiclar masses are there?

Answer 0

Hydroocoele
spermatocoele
epididymal cyst
Variicoocoele
Epididymitis/Orchitis

Question 1

Which is usually more severe, and intra testicular or extra testicular mass?

Answer 1

Intratesticular - usually malignant

Question 2

What is a varicocoele described as?

Answer 2

A bag of worms. dilated tortuous veins.

Question 3

What test culd you use to determine if it is epidiymitis?

Answer 3

Prehn’s sign - if you lift up the testicle it should relieve the pain.

Question 4

What would you feel if someone had an epididymal cyst?

Answer 4

firm mass, separate to testis, able to feel above it.

Question 5

What type of tumours do you find in the testicle?

Answer 5

95% are germ cell tumours, which are either seminomas or non-seminomas (eg. teratoma).
5% are non germ cell tumours, such as lymphoma or an adenoma

Question 6

Where is a seminoma derived from?

Answer 6

Germline epithelium of the seminiferous tubules.

Question 7

What is a teratoma in the testis like?

Answer 7

An encapsulated tumour showing characteristics of normal cell type derivatives from multiple germ layers.

Question 8

What is CIS in the testis?

Answer 8

Carcinoma in situ. A flat pre-cancerous lesion, 50% will become an invasive cancer in 5 years. Hard to pick up, as doesn’t feel like a lump.

Question 9

What are the risk factors for icreased testicular cancer?

Answer 9

Cryptochidism- undecended testicles
testicular atrophy in the past - maybe due to infection, chemicals, trauma. 
Hernias
Hydrocoele
Abnormal development syndromes.

Question 10

How would someone present with a testicular lump?

Answer 10

Painless swelling of testis
30-4-% have a dull ache
10% present with metastaces - resp probs, GI issues, bone pain, lower limb swelling
5% gynaecomastia

Question 11

What is gynaecomastia a sign of?

Answer 11

systemic endocrine dysfunction

Question 12

What investigations would you do if someone had a suspected lump?

Answer 12

Examination - palpate for mass, look at symmety..
Scrotal US - URGENT
MRI if possible/available
Measure tumour markers

Question 13

What tumour markers are seen in testicular cancer?

Answer 13

b-HCG - in teratoma
AFP - in teratoma mainly
LDH - In seminoma - less specific but good to look at treatment and if it is working and getting less ect.

Question 14

How do you manage a testicular cancer?

Answer 14

Rapid removal of testis - orchidectomy - radical treatment

Question 15

What is more common, prostate cancer or testicular cancer?

Answer 15

Prostate cancer is most commonly diagnosed cancer in males.
10% lifetime risk in males
4th most common cancer death in males.

But testicular cancer is most common in men aged 15-35.

Question 16

What risk factors are there to prostate cancer?

Answer 16

Age - increases exponentially after 50yrs
Ethnicity/Race, highest in N america and Europe. Higher risk in black males in UK than white.
Family history - especially if close degree relative. 10% are genetically linked, BRAC2 gene implicated.

? link with fat intake, horones, vasectomy, enviironment

Question 17

How would someone with prostate cancer present?

Answer 17

Often will have very little symptoms.
Maybe have local problems (voiding difficulty, irrative, impotence) or metastatic symptoms (bony pain, anaemia, lymphodema, renal failure).

Question 18

What investigations are available for ? prostate cancer?

Answer 18

PSA - blood test. high = 50%will have cancer.
DRE - digital rectal examination - feel for enlargement/abnormalities
TRUS - Trans rectal US / biopsy - histology to stage it.

Question 19

Why isn’t PPSA screening offered to all?

Answer 19

It isn’t completely sensitive. Misleading, if there is a current infection or if there has already been manipulation of the urinary tract. 20% with prostate cancer have normal PSA levels.
You would need to do many PSA screenings to discover one person with actual cancer - not viable.

Question 20

What treatment can be offered for prostate cancer?

Answer 20

Depends on tumour and staging.
- active surveillance
- radical prostatectomy
- Radical radiotherapy
\+/- hormone ablation therapy
- Brachytherapy

Question 21

What can be used if there are boney mets?

Answer 21

Bisphosphonates

Question 22

What is the general principle behind chemotherapy?

Answer 22

Chemo drugs interfere with DNA synthesis or key mechanisms in cell replication. As tumour cells tend to be replicating more rapidly, and have defective DNA repair mechanisms, the chemo drugs affect them more than normal cells. This does mean that there is a narrow therapeutic range.