4: Testicular & Penile Cancer Flashcards
what is the epidemiology of testicular cancer
- most common in ages 15-45
- Caucasian and Northern European at highest risk
how are primary testicular tumours categorised
- germ cells (GCT) 95%
- non germ cell (NGCT) 5%
how are GCTs further categorised
- seminom
- non-seminomatous (NSGCT)
- usually malignant
what are the characteristics of NGCTs
- usually benign
- Leydig or Sertoli cell tumours
- seminomas remain localised until late and have v good prognosis
- NSGCTs metastasise early and have worse prognosis
what are examples of NSGCTs
- yolk sac tumours
- choriocarcinoma
- embyronal carcinoma
- teratoma
what are risk factors of testicular cancer
- cryptorchidism
- previous malignancy
- positive FHx
- Kleinfelter’s
what is the typical presentation of testicular cancer
- unilateral painless testicular lump which is typically irregular, firm, fixed and does not transilluminate
- systemic symtpoms if metastatic e.g. weight loss, back pain or dyspnoea
what are the key investigations in testicular cancer
- tumour markers
- scrotal ultrasound ! then CT w contrast of chest-abdo-pelvis for staging
what tumour markers would you be looking for in testicular cancer (3)
- AFP: raised in some NSGCTs but not in pure seminoma
- BHCG: elevated in 60% NSGCTs and 10% pure seminoma
- LDH: surrogate marker for tumour volume and necrosis + response to oncological treatment
what investigation would NOT be performed in testicular cancer and why
trans-scrotal percutaneous biopsy as it might cause seeding of the cancer
how is testicular cancer staged
Royal Marsden
what is the prognosis of testicular cancer
98% 5 year survival
- majority cured even w metastatic disease
what is the treatment of testicular cancer
- inguinal radical orchidectomy: allows for limited lymphatic disruption
- if high-volume metastatic disease then upfront chemo (sperm banking and testicular prosthesis insertion)
- retroperitoneal lymph node dissesction for residual NSGCT masses after chemo
what is penile cancer strongly associated with
HPV 16,6,18
what is the most common penile malignancy
squamous cell carcinoma (SCC) arising from epithelium of inner prepuce/glans
- others e.g. basal cell, sarcoma, melanoma, urethral carcinoma
what are risk factors of penile cancer
- HPV
- phimosis
- smoking
- lichen sclerosis
- untreated HIV
how does penile cancer present
- palpable or ulcerating lesion on penis
- commonly on glans
- typically painless but can produce discharge and prone to bleeding
- inguinal lymphadenopathy present 30-60%
what investigations are necessary in penile cancer
- refer to specialist centre
- penile biopsy
- PET-CT imaging and CT chest-abdo-pelvis for complete staging
how is superficial non-invasive penile cancer treated
topical chemo e.g. F-fluorouracil
- laser treatment or glans resurfacing
how are most cases of penile cancer managed
surgical
- invasive disease confined to glans: organ sparing treatment e.g. local excision, partial glansectomy or total w reconstruction
- total penectomy w perineal urethrostomy +/- neoadjuvant RT or chemo
- inguinal node involvement may need radical inguinal lymphadenectomy
describe the pattern of penile cancer metastasis
inguinal lymph nodes –> pelvic lymph nodes
