138 Testicular lump and bone pain

Question 1

What is the cause of 95% of testicular germ cell tumours?

Answer 1

seminomas

Question 2

What are the RF for testicular cancer?

(5 listed)

Answer 2

1. cryptorchidism
2. testicular atrophy
3. inguinal hernia
4. hydrocoele
5. abnormal testicular development

Question 3

In which generation is testicular cancer more prevalent?

Answer 3

Younger males

Question 4

Which geographical areas are more susceptible to get testicular Ca?

Answer 4

• Northern Europe
• Isreal
• Maori

Question 5

What clinical presentation would be a strong indicator to examine the testes when suspecting testicular Ca?

Answer 5

Gyneacomastia

Question 6

Which genes are associated with testicular Ca?

Answer 6

• RB
• p53

Question 7

What does CIS of testes look like clinically? What happens with time?

Answer 7

Flat lesions –> solid metastatic disease

Question 8

Which investigations should be performed when suspecting testicular Ca?

(3 listed)

Answer 8

1. scrotal USS
2. MRI
3. Bloods
   
   • α fetoprotein
   • β hCG
   • LDH

Question 9

What are the risks of an orchidectomy?

Answer 9

• infertility
• hypogonadism

Question 10

What is the management of Stage 1 seminoma?

(3 choices listed)

Answer 10

• adjuvant RTx
• adjuvant chemo –> 2 courses of carboplatin
• surveillance

Question 11

What is the best option for treatment of a non-seminomatous germ cell tumour which doesn’t have vascular invasion?

Answer 11

2 cycles of chemo

Question 12

What percentage of males will have microscopic prostate disease at 50yrs?

Answer 12

30%

Question 13

What percentage of men will have microscopic prostate disease at 80yrs?

Answer 13

70%

Question 14

What is the lifetime risk of developing prostate Ca?

Answer 14

30%

Question 15

What is the lifetime risk of dying from prostate cancer?

Answer 15

3%

Question 16

Which gene in the FH would dramatically increase the risk of a man developing prostate Ca?

Answer 16

BRCA1 in mother

Question 17

Which protein is used as a tumour marker to detect germ cell tumours but is not produced by seminomas?

Answer 17

α- feto protein

Question 18

Which tumour marker is produced by both seminomas and non-seminomas?

Answer 18

β-hCG

Question 19

Which tumours are usually benign?

• intratesticular
• extratesticular

Answer 19

extratesticular

Question 20

Which race are at higher risk of developing prostate Ca in UK?

Answer 20

Black males

Question 21

On which side are varicocoele’s most commonly found?

Answer 21

• left –> left tesicular vein drains into the left renal vein whereas the right drains into the IVC

Question 22

Which lymph nodes are involved in testicular cancer?

Answer 22

Para-aortic lymph nodes

Question 23

Which lymph nodes are involved with advanced penile cancer?

Answer 23

Inguinal lymph nodes

Question 24

Which chromosome is PSA associated with?

Answer 24

Chromosome 19

Question 25

When should a PSA not be performed?

Answer 25

During active infection or urinary retention

Question 26

When might PSA be falsly elevated?

Answer 26

• Following ejaculation
• After cycling
• in BPH
• prostatitis
• UTIs
• TRUSS
• retention

Question 27

What symptoms are usually associated with prostate cancer?

Answer 27

• obstructive voiding symptoms
• irritative symptoms e.g. urgency, frequency
• haemospermia
• impotence

Question 28

What is abiaterone used to treat?

Answer 28

Prostate cancer - hormone ablative therapy

Question 29

What are docetaxel and carbazzitaxel used to treat?

Answer 29

Chemotherapy for prostate cancer

Question 30

Which 2 types of drugs can be used in the treatment of BPH?

Answer 30

• α blockers
• 5α-reductase inhibitors

Question 31

What are the drugs used to treat cancer, shortened to BEP?

Answer 31

• Bleomycin
• Etoposide
• Cisplatin