Testicular Ca

Question 1

differentials for a painful testicular mass

Answer 1

Sudden
- testicular torsion
- appendix torsion
- trauma
- incarcerated hernia
Gradual
- acute epididymtis and epididymo-orchitis

Question 2

ddx for painless testicular mass

Answer 2

fluid-filled
- epididymis ➔ cyst or spermatocele
- spermatic cord: communicating hydrocele or indirect hernia
- hydrocele ➔ traumatic or reactive
solid
- tumour
- varicocele: bag of worms

Question 3

def of testicular ca

Answer 3

cancer within the testes
- germ cell: seminomas (most common) and non-seminomas and mixed tumours
- non-germ cell: Leydig and Sertoli cell tumour

Question 4

epi for testicular ca

Answer 4

most common malignancy in men 15-45Y

Question 5

RF for testicular ca

Answer 5

• cryptorchidism (undescended testes)
• fhx
• prev trauma to testes
• infection: HPV, EVB, CMV, and HIV
• tall, white, or infertile
• genetics: Klinefelter syndrome

Question 6

Prognosis for testicular ca

Answer 6

one of the most curable cancers

Question 7

red flags for testicular ca

Answer 7

firm nodule/mass
“feels different”
persistent abdo, back, or flank pain
skin changes to the scrotum
gynecomastia
LAD

Question 8

how likely does seminomas in testicular cancer met? is it aggessive? tx implications?

Answer 8

not likely, slow growing
chemo and radiosensitive

Question 9

how likely do non-seminomas in testicular ca met? is it aggressive? tx implications?

Answer 9

likely to met, grows and spreads quicker
chemosensitive but not as radiosensitive

Question 10

how does testicular cancer develop?

Answer 10

there is some sort of tumorigenic event in utero which later post-birth manifests as tumour/cancer

Question 11

common sites of mets for testicular cancer?

Answer 11

LN, lungs, liver, brain, and bone

Question 12

Ix for testicular cancer?

Answer 12

1. hx - look for RF (cryptorchidism and fhx)
2. physical - scrotal exam, palpate, consider transillumination, abdo, groin, and supraclavicular nodes
3. scrotal u/s
4. serum tumour markers: AFP, hCG, LDH

dx is based on clinical findings on scrotal u/s and elevations in serum tumour markers

Question 13

how to tx testicular cancer?

Answer 13

1. refer to urology and surg onc and fertility clinic
2. resection of malignant testes - radical orchiectomy +/- LN
3. advanced stages: adjuvant chemo (alkylating agent) and radiation depending on pathology