Cancer - Testicular

Question 1

Main type of testicular cancer?

Answer 1

95% are Germ Cell Tumours
5% are Non-Germ cell tumours

Either Seminomatous GCT (30s/40s) or Non-seminomatous GCT (aka teratoma, 20s/30s)

5% are Non-GCT

Question 2

What kinds of germ cell tumours are there and who do they affect?

Answer 2

Seminomatous germ cell tumour - 30/40 yr olds

Non-seminomatous germ celll tumour - AKA teratoma - affects 20-30 y/o’s

Question 3

How does testicular cancer present?

Answer 3

Usually just a painless lump

Less often presents with:

• Tender inflammated swelling
• Trauma history
• Metastatic symptoms (chest/bone/para-aortic lymph nodes)

Question 4

Differentials for testicular lumps?

Answer 4

Cancer
Infection - epididymo-orchitis
Epididymal cyst
A missed testicular torsion

Question 5

Risk factors for testicular cancer?

Answer 5

Age - 3rd decacde
Caucasian 
Infertility
Testicular maldescent
Atrophic testes

Question 6

What tests can be done for Testicular Cancer?

Answer 6

MSSU
Testicular ultrasound/X-ray
Tumour markers

Question 7

What tumour markers do you look for and what type of cancer do they indicate?

Answer 7

Alpha-fetoprotein (AFP) - Teratoma

Beta-HCG (Human chorionic Gonadotrophin) - Seminoma

LDH (Lactate Dehydrogenase)) - Non-specific

Question 8

Initial testicular cancer treatment?

Answer 8

Radical Orchidectomy - may need to biopsy the other testes to make sure it has not spread

Question 9

2y treatment?

Answer 9

Depends on the stage

• Low and neg markers = Surveillance and maybe RT/chemo
• Nodal/relapse/persistent markers = chemo or lymph node dissection
• Mets = needs chemo

Question 10

Prognosis?

Answer 10

Very good
Stage 1 - 99% 5 yr survival
Stage 4 - 73% 5 yr survival

Question 11

How do we grade testicular cancer?

Answer 11

Grade - Assesses aggression based on differentiation

Well differentiated = less aggressive
Poorly differentiated = very aggressive

Question 12

How do we stage ?

Answer 12

Staging is the assessment of spread which occurs in 3 ways.

1. Local - local invasion to nearby structures
2. Regional - spread to lympatics
3. Distant - invasion of lungs, bone, liver

Staged using TNM system

Question 13

4 Stages of Testicular Cancer?

Answer 13

Stage 1 -Testis Disease
Stage 2 - Infradiaphragmatic nodes
Stage 3 - Supradiaphragmatic Nodes
Stage 4 - Extralymphatic Disease