6.5. Cancer - Testicular Cancer Flashcards
What is the significance of Testicular Cancer?
This is one of the commonest cancers in young men
What is the peak age of incidence of Testicular Cancer?
The 3rd Decade
What is the Aetiology of Testicular Cancer?
It is unknown
What is a precursor lesion to Testicular Cancer?
Testicular Germ Cell Neoplasia In-Situ
What are the risk factros involved in Testicular Cancer?
- Being Caucasian
- Testicular Maldescent
- Infertility
- Atrophic Testis
- Previous Cancer in the Contralateral Testis
What type of Tumours are in Testicular Cancer?
- Germ Cell Tumours (GCT) - 95%
2. Non-GCT - 5%
What are the two types of Germ Cell Tumours involved in Testicular Cancer?
1, Seminomatous
2. Non-Seminomatous
What age group is most likely to present with Seminomatous Germ Cell Tumours?
30-40 year olds
What age group is most likely to present with .Non-Seminomatous Germ Cell Tumours?
20-30 year p;ds
What are the 3 sub-types of Seminomatous Germ Cell Tumours?
- Classic
- Spermatocyte
- Anaplastic
What are the 3 sub-types of Non-Seminomatous Germ Cell Tumours?
- Teratomas
- Choriocarcinoma
- Miced Germ Cell Tumour
What are the Non-Germ Cell Tumours (5%) due to?
Carcinoma of the Sex Cord / Stroma
What are the Ckinical Features of Testicular Cancer?
- Painless Lump
- Inflamed Swelling
- History of Trauma
- Lymphadenopathy
- Metastatic Symptoms
What is the most common presentation of Testicular Cancer?
A painless lump
What is a less common presentation of Testicular Cancer?
An inflamed swelling which can be tender
Where can Lymphadenopathy occur immediately?
The Para-Aortic Lymph Nodes
Where can Testicular Cancer Metastasis to?
- Lung
2. Bone
what investigations are necessary for Testicular Cancer?
- Physical Examination
- Mid-Stream Sample of Urine
- Testicular Ultrasound
- Blood Tests
- CT Scan
- Biopsy
- Contralateral Biopsy
What is the purpose of the Physical Examination?
To exclude:
- Infection (Epididymo-Orchitis
- Hernia
- Cyst
What is the purpose of the Mid-Stream Sample of Urine?
To exclude infection
What is the purpose of the Testicular Ultrasound?
To visualize the Testis and exclude a Cyst
What are the Blood Tests looking for?
Tumour Markers:
- Alpha-Fetoprotein
- Human Chorionic Gonadotrophin
- Lactate Dehydrogenase
What is the purpose of the CT Scan?
To check for Nodal, and Chest/Abdomen/Pelvic Metastases for Staging purposes
What is the purpose of the Contralateral Biopsy?
To ensure that this is not bilateral
What can be determined from biopsy of the Tumour?
The Tumours Grade
What staging system is used for Testicular Cancer?
TNM staging
What are the different stages of Testicular Cancer?
Stage 1 - T1N0M0 - Disease is confined to the Testis
Stage 2 - TxN1M0 - Infradiaphragmatic Nodes are involved
Stage 3 - TxN2M0 - Supradiaphragmatic Nodes are involved
Stage 4 - T1NxM1 - Extra Lymphatic Disease
What is the 5 year survival rate for a Stage 1 (T1N0M0)?
99%
What is the 5 year survival rate for a Stage 2 (TxN1M0)?
96%
What is the 5 year survival rate for a Stage 3 (TxN2M0)?
96%
What is the 5 year survival rate for a Stage 4 (TxNxM1)?
73%
What treatment is required for Testicular Cancer?
Radical Orchidectomy followed by specific therapy dependent on the Stage
What specific therapy is required following a Radical Orchidectomy, in a Stage 1 Testicular Cancer?
- Surveillance
2a. Adjuvant Radiotherapy
OR
2b. Prophylactic Chemotherapy
What specific therapy is required following a Radical Orchidectomy, in a Stage 2/3 Testicular Cancer?
Combination Chemotherapy
OR
Lymph Node Dissection
What specific therapy is required following a Radical Orchidectomy, in a Stage 4 Testicular Cancer?
1st Line Chemotherapy then 2nd Line Chemotherapy
