FunMed: PBL 7 (Testicular Cancer)

Question 1

What increases the risk of developing testicular cancer?

Answer 1

Undescended testicles in infancy, indirect inguinal hernias in infancy, family history, being tall and marijuana use

Question 2

Define orchidopexy

Answer 2

Operation to place undescended testis into scrotum

Question 3

Define haematocrit

Answer 3

Ratio of volume of RBCs to total blood volume

Question 4

What is alpha fetoprotein?

Answer 4

protein produced by foetus which is present in amniotic fluid and the bloodstream of mother

Question 5

What is lactate dehydrogenase?

Answer 5

Converts lactate to pyruvate

Question 6

What are the symptoms of testicular cancer?

Answer 6

Firm (often painless) mass of ump on testicle - can cause achy pain, growth/swelling of testicle, abnormality in shape/consistency between testicles, associated abdominal pain

Question 7

Name the aspects of the testicle

Answer 7

Epididymis (feeds into spermatic cord/vas deferens), testis (seminiferous tubules –> straight tubules –> rete testis –> efferent ductules)

Question 8

Why is alpha fetoprotein tested for?

Answer 8

Typically elevated in yolk sac tumour

Question 9

Why is beta hCG tested for?

Answer 9

typically elevated in choriocarcinomas and NSGCTs

Question 10

Why is lactate dehydrogenase tested for?

Answer 10

Shown to correlate with tumour burden in NSGCTs and some seminomas

Question 11

What are the two main types of testicular cancer?

Answer 11

Seminomas and non-seminomas (common in younger patients)

Question 12

What proportion of testicular cancers are germ cell cancers?

Answer 12

~95%

Question 13

What is meant by tumour staging?

Answer 13

Indicates how far advanced it has become e.g. metastasis

Question 14

Outline the stages of testicular cancer

Answer 14

Stage I - contained in testicle
Stage II - lymph node spread but no distant metastasis
Stage III - spread to thorax lymph nodes
Stage IV - spread to another organ e.g. lungs

Question 15

Where does lymph drain from the testes?

Answer 15

Para-aortic lymph nodes

Question 16

Where does lymph from the scrotum drain?

Answer 16

Superficial inguinal lymph nodes

Question 17

What does NSGCTs stand for?

Answer 17

non-seminomatous germ cell tumors

Question 18

What does RPLND stand for?

Answer 18

Retroperitoneal lymph node dissection

Question 19

What is the treatment for non-seminomatous germ cell tumours?

Answer 19

Retroperitoneal lymph node dissection and radical orchiectomy

Question 20

Describe how to perform testicle self-examination

Answer 20

Roll testicle between thumb and forefinger to check whole surface free of lumps and familiarise self with feel of epididymis collecting tube (behind testicle), inspect each testicle individually

Question 21

When and where should testicular self-examination be conducted?

Answer 21

Monthly basis after a warm bath or shower (relaxes scrotal skin)

Question 22

Define gynaecomastia

Answer 22

Benign enlargement of male breast tissue

Question 23

Outline the checkpoints in the cell cycle

Answer 23

G1-S: checks organelle replication, have enough organelles to divide
G2-M: DNA replication appropriate and accurate
Mitosis (metaphase): chromosomes attached appropriately to spindle

Question 24

What things must be present in order for someone to give informed consent?

Answer 24

Patient must be competent (have capacity)
Patient must be offered adequate information (adequate disclosure)
Patient’s decision must not be coerced (Non-coercion)

Question 25

What is the role of the lymphatic system?

Answer 25

Removal of interstitial fluid from tissues, absorbs and transports fatty acids from GI tract, transports WBCs, transports APCs such as dendritic cells to nodes –> immune response activation

Question 26

What type of tumour does this individual have?

Answer 26

Non-seminomatous germ cell tumour

Question 27

What is a radical orchiectomy?

Answer 27

Removal of one or both testes where entire spermatic cord is removed too

Question 28

Define non-seminomatous

Answer 28

Any of a variety of histologic types of testicular carcinoma including embryonal cell carcinoma, teratocarcinoma an tumours with mixed elements