Testicular

Question 1

What are some risk factors for testicular cancer?

Answer 1

Cryptorchism (higher risk for abdominal then ingiunal)
Age 15-40
HIV
Klinefelters
Down syndrome
Caucasian
Family history

Question 2

Clinical,features of testicular cancer?

Answer 2

Firm rubbery lump, some present with acutely painful testicle
Symptoms from metastatic disease - back pain, sob, CNS
Paraneoplastic limbic encephalitis
Gynaecomastiamifmhigh production of BHCG
Abdominal ache

Question 3

Diagnosis of testicular cancer?

Answer 3

Ultrasound
CT abdo/ pelvis (chest if symptoms or CXR abnormal)
Tumour markers (LDH, B hCG, AFP)
CNS imaging if symptoms
Removal of testis for histology

Question 4

What are the differences between NSGCT (nonseminoma) and seminoma?

Answer 4

NSGCT

• contain either embryonal, choriocarcinoma, yolk sac tumour, teratoma or a mixture
• if AFP is high can only be NSGCT (produced by yolk sac cells)
• tend to be more aggressive, present at a more advanced stage

Seminoma

• most present with localised disease
• indolent
• BHCG and LDH can be raised but not AFP
• consist of only pure seminoma (if any other component = NSGCT)
• metastases less through blood to distant sites then NSGCT

Question 5

What are the risk stratification for advanced seminoma?

Answer 5

Good risk

Intermediate risk - have metastasis outside of lung and lymph nodes

Question 6

What is the risk stratification for advanced non-seminoma?

Answer 6

Good risk - pulmonary or nodal risk with low tumour markers
Intermediate risk
Poor risk - metastases other then lung and nodes + higher tumor markers

Question 7

What is the staging for Testicular germ cell tumors?

Answer 7

Stage 1 - localised to testis
Stage 2 - localised to lymph nodes
Stage 3 - metastatic disease

Question 8

What subtypes make up testicular cancer?

Answer 8

Germ cell tumours = seminoma and nonseminoma
Sex cord stromal tumors (Leidig, Sertoli cell)
Lymphoma and metastatic disease from other primaries

Question 9

What is the treatment of seminoma following orchiectomy?

Answer 9

Stage 1 - surveillance is preferred, however if high risk features (rete testis invasion + large tumour greater then 4cm) can consider single dose carboplatin
Advanced disease - 3-4 cycles of BEP chemotherapy (Bleomycin/etoposide/cisplatin) followed by resection of residual disease

Question 10

What is the treatment of non-seminoma following orchiectomy?

Answer 10

Stage 1 - surveillance vs retroperiotneal lymph node dissection vs 1-2 cycles BEP (later 2 options for higher risk disease
Advanced - 3-4 cycles BEP chemotherapy
Resection of residual masses

Question 11

What is the prognosis of testicular cancer?

Answer 11

Good risk TGCT - 5 year OS 92%

Poor risk NSGCT - 5 year OS 48%

Question 12

What is the feared side effect of bleomycin?

Answer 12

Lung toxicity - pulmonary fibrosis with oxygen toxicity (worsening of fibrosis with high flow oxygen administration)
Need regular Lung function tests

Question 13

What are some side effects of cisplatin?

Answer 13

Highly emetogenic
Electrolyte wasting
Renal impairment 
Hearing impairment
Peripheral neuropathy