Background Flashcards
Clinically, what are the 2 main subgroups of testicular germ cell tumors (GCTs)?
Seminomatous and nonseminomatous germ cell tumors (NSGCTs) are the 2 main subgroups of testicular GCTs. 60% are pure seminoma, 30% are NSGCTs, and 10% are mixed (pts with mixed histology are typically considered to have NSGCTs).
What is the estimated annual incidence and mortality from testicular cancer in the United States? Has the incidence been increasing or decreasing?
In the United States, the annual testicular cancer incidence is ˜8,700 and mortality is ˜380. From 1973 to 1998, the incidence in testicular GCTs rose 44% in the United States (mostly seminoma).
What is the most common age group for testicular seminoma?
Testicular seminoma is most common in those 15–34 yrs of age.
In the United States, what is the relative incidence of testicular tumors in white men vs. black men?
Testicular cancer is 5.4 times more common in white men than in black men.
What is the best established risk factor for testicular cancer?
A Hx of cryptorchidism increases the risk of testicular cancer by ∼5 times. The higher the undescended testicle (inguinal canal vs. intra-abdominal), the higher the risk. Orchiopexy prior to puberty lowers this risk. 5%–20% of tumors in pts with a Hx of cryptorchidism develop in the contralat, normally descended testis. The risk is greatest in cases of bilat cryptorchidism.
In a pt with a prior Dx of testicular cancer, what is the cumulative incidence (at 25 yrs) of contralat testicular seminoma?
t 25 yrs following the primary Dx, the cumulative incidence of contralat testicular seminoma is 3.6%.
What is the most common chromosomal abnormality in testicular GCTs?
A 12p isochromosome (i.e., a chromosome with 2 copies of the short arm of chromosome 12) is the most common testicular GCT chromosomal abnormality.
Name the layers of tissue surrounding the testes from outer to inner.
Layers of tissue surrounding the testes (outer to inner):
Skin Tunica dartos External spermatic fascia Cremaster muscle Internal spermatic fascia Parietal layer of tunica vaginalis Visceral layer of tunica vaginalis Tunica albuginea
Compare and contrast lymphatic drainage of the left vs. right testis.
Left testicular vein → left renal vein → nodal drainage is primarily to the P-A nodes
Right testicular vein → IVC → paracaval and interaortocaval nodes are most commonly involved (Lymphatic drainage from the right testes commonly crosses over to the left, but the reverse is rare).
What is the chance of pelvic/inguinal nodal involvement from testicular cancer? What increases this risk?
Pelvic/inguinal nodes are rarely (<3%) involved by testicular cancer. Risk of involvement increases with:
Prior scrotal or inguinal Sg
Tumor invasion of the tunica vaginalis or lower one-third of epididymis
Cryptorchidism
What is the DDx of a testicular mass?
The DDx of a testicular mass includes tumor, torsion, hydrocele, varicocele, spermatocele, and epididymitis.
What is the classic presentation of testicular cancer?
A painless testicular mass is the classic presentation of testicular cancer. However, up to 45% of pts will present with pain.
