Testicular Flashcards
1
Q
Most common type
A
Germ cell tumour (95%) - HIGHLY METASTATIC
Also arise in retroperitoneum and mediastinum
Non-seminomatous (60%) - teratoma, yolk sac tumours
Seminous (40%)
2
Q
Lymphatic spread
A
Para-aortic nodes
3
Q
Blood spread
A
Lungs, liver, boine and brain
4
Q
RF
A
15-25yrs Caucasian FH Cryptochordism Testicular atrophy
5
Q
Presentation
A
Typical - painless testicular swelling
Metastatic
- lung = cough, SOB
- para-arotic = lower back pain
6
Q
Investigations
A
- Testicular USS (can differentiate teratoma from seminoma)
- Tumour markers
- b-HCG (raised in both types)
- AFP (only raised in non-seminous)
- LDH = marker for prognosis - Orchidectomy - guides definitive treatment
- Biopsy of C/L testicle for cryptochordism patients
- CT - staging
7
Q
Staging
A
1 = confined to testicle 2 = para-aortic below diaphragm 3 = para-aortic above diaphragm 4 = visceral mets
8
Q
Management
A
- Orchidectomy = 1st line (done through iguinal conal to avoid spread through scrotal tissue)
- do biopsy during op
- can be done as adjuvant after chemo - Chemo - depends on type - v. responsive to chemoRx
- Non-seminous = Carboplatin
- Seminous = BEP (bleomycin, etoposide, cisplatin - Radiotherapy
- for para-aortic nodes
- Adjuvant chemo-RTx for malignant teratoma
- Palliative - bone, brain and nodes
9
Q
Prognosis (non-seminoma)
A
Non-seminoma:
- Good (92%) = AFP<1,000ng/ml, bHCG <5000 IU/L, LDH <1.5 normal limit
- Poor (48%) = >10,000ng/ml, bHCG >50,000 IU/L, LDH>10 x upper limit