GU Cancer: Testicular Cancer

Question 1

Definition

Answer 1

Most common cancer in 20-30 years. Around 95% of cases of testicular cancer are germ cell tumours. Germ cell tumours may essentially be divided into:
- seminomas:
- non-seminomas: including embryonal, yolk sac, teratoma + choriocarcinoma
Non germ cell tumours include Leydig cells + sarcomas

Question 2

Epidemiology

Answer 2

Male
20-30
Seminoma > 35
Non seminoma < 35

Question 3

Risk factors

Answer 3

Infertility (Increased risk times 3)
Cryptorchidism
Family history
Klinefelter’s syndrome
Mumps orchitis

Question 4

Signs and symptom

Answer 4

Signs:
- firm non tender testicular mass
= does NOT transilluminate
= hydrocele may be present
- Supraclavicular lymphadenopathy
Symptoms:
- Painless testicular lump: MC
- Symptoms of raised B-hCG
= gynecomastia: due to increased oestrogen: androgen ratio
= hyperthyroidism
- bone pain = skeletal mets
- breathlessness = lung mets

Question 5

Pathophysiology

Answer 5

Germ cell tumours - hCG - Leydig cell dysfunction - increases in both oestradiol + testosterone production. But rise in oestradiol is relatively greater than testosterone
Leydig cell tumours = directly secrete more oestradiol + convert additional androgen precursors to oestrogens

Question 6

Diagnosis

Answer 6

FIRST LINE = Ultrasound testicular Doppler
CXR if symptomatic for pulmonary mets
Tumour markers (not usually raised): B-hCG, LDH, AFP
- seminomas: hCG may be elevated in 20%
- non-seminomas: alpha fetoprotein (AFP) = raised in teratoma +/or beta-hCG elevated in 80-85%
- LDH is elevated in 40% of germ cell tumours
* IMPORTANT: Fine needle aspiration must not be performed due to risk of seeding. Histological examinations may be performed post-orchiectomy *

Question 7

Treatment

Answer 7

FIRST LINE = Urgent radical orchidectomy (+ offer sperm storage)
+ adjunctive chemo or radiotherapy