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%)

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2
Q

Lymphatic spread

A

Para-aortic nodes

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3
Q

Blood spread

A

Lungs, liver, boine and brain

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4
Q

RF

A
15-25yrs
Caucasian 
FH
Cryptochordism 
Testicular atrophy
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5
Q

Presentation

A

Typical - painless testicular swelling

Metastatic

  • lung = cough, SOB
  • para-arotic = lower back pain
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6
Q

Investigations

A
  1. Testicular USS (can differentiate teratoma from seminoma)
  2. Tumour markers
    - b-HCG (raised in both types)
    - AFP (only raised in non-seminous)
    - LDH = marker for prognosis
  3. Orchidectomy - guides definitive treatment
  4. Biopsy of C/L testicle for cryptochordism patients
  5. CT - staging
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7
Q

Staging

A
1 = confined to testicle
2 = para-aortic below diaphragm
3 = para-aortic above diaphragm
4 = visceral mets
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8
Q

Management

A
  1. Orchidectomy = 1st line (done through iguinal conal to avoid spread through scrotal tissue)
    - do biopsy during op
    - can be done as adjuvant after chemo
  2. Chemo - depends on type - v. responsive to chemoRx
    - Non-seminous = Carboplatin
    - Seminous = BEP (bleomycin, etoposide, cisplatin
  3. Radiotherapy
    - for para-aortic nodes
    - Adjuvant chemo-RTx for malignant teratoma
    - Palliative - bone, brain and nodes
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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
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