Bone Pain and testicular lump - 138 Flashcards
What kind of tumour is testicular cancer most commonly due to?
Germ cell tumours - these represent 95% of testicular tumours.
What 2 types of tumour can GCTs be?
Seminomas (45%)
Non-seminomas, e.g. teratomas (50%)
When are seminomas rare?
Before 10 years and after 60 years
What are the risk factors for GCTs?
Cryptochidism, testicular atrophy, inguinal hernia, hydrocoele, syndromes with adnormal testicular development (e.g. klinefelters)
What virus is associated with testicular cancer?
Mumps -> 10% of men with GCTs had mumps
Name some signs and symptoms of GCTs
Painless swelling/lump, dull ache/heavy sensation, acute testicular pain, metastases, gynaecomastia
How is a GCT of the testis diagnosed?
Physical examination. Scrotal USS -> sensitivity is almost 100%. Serum tumour markers -> these can be prognostic and help staging
Name some serum tumour markers associated with a testicular cancer and when they might be raised
- a-FP -> Raised in 50-70%. Suggests a non-seminomas tumour ONLY (also produced in liver damage)
- b-hCG -> produced by seminomas and non-seminomas (and some other cancers). Raised 30% of time
- LDH -> this is an indicator of relapse
What is a hydrocoele?
A collection of fluid within the tunica vaginalis. It is usually benign (unless it’s underlying a secondary pathology). Occurs in over 70s or infants
What is the most common aeitology of a hydrocoele in over 70s and infants?
Adults - Excessive fluid production or inflammation/infection
Infants - patent processus vaginalis
What is an epididymal cyst?
Extra-testicular fluid filled benign cyst. Usually in head of epididymis.
What is a spermatocoele?
A sperm filled benign cyst, distended tubule from rete testis or epididymis.
What investigations would be done for an epididymal cyst or spermatocoele? How would they be managed?
Transillumination. USS.
Managed conservatively if asymptomatic. If cyst infected tetracycline can be given to shrink cyst. `
What is a varicocoele?
An abnormal dilatation of veins of pampiniform plexus. Can be associated with infertility.
Why is a varicocoele more common on the L side?
Due to the 90* angle and inadequate valves as the L testicular vein enters the L renal vein -> can cause a back pressure.
Would you examine a varicocoele whilst the patient is sitting or standing?
Standing -> pressure and dilatation. Cough also increases pressure.
What is the most common cause of epididymitis?
Ascending infection from the urethra. Could be due to an STI.
Gram -ve infection (E.coli) most common in under 35s.
What are risk factors for torsion of the testicle?
Bell-clapper deformity (tunica vaginalis attaches at top of testis, no scrotal wall attachment), cryptoorchidism (partially descended testis)
How would a patient with torsion of the testis present? How would it be managed?
Acute pain, radiation to abdomen and back, vomiting, swollen, tender and retracted testicle, scrotal colour change.
Medical emergency - immediate surgical exploration and management
