Testicular Cancer Flashcards
Define Testicular Cancer
Malignancy of the testicular cells
What are the types of Testicular cancer
Germ cell tumours: seminoma | embryonal carcinoma | yolk sac | teratoma
Germ cell and sex cord-stromal elements: Gonadoblastoma
Describe seminomas
Most common
Malignant tumour with slow growth and late metastases
Secretes placental alk phos (PLAP)
Microscopic:
Fried egg cell (big germ cell with central nuclei)
Fibrous septae
Describe embryonal tumours
Derived from germ cells that will develop into embryonic pluripotent stem cells
Small and painful
Aggressive
Describe teratomas
Can contain any type of tissue e.g. skin, hair, nails, bone, teeth, muscle
Mature - cyst with fully developed tissue, usually appears in children
Immature - undifferentiated tissues, usually in adults
Describe choriocarcinomas
Derived from germ cells that will produce syncytiotrophoblasts and cytotrophoblasts
Small but malignant (most aggressive)
Rapid growth which results in ischaemia and necrosis from inadequate blood supply
Secretes hCG
Describe Yolk Sac tumours
Most common tumour in children
Aggressive, with high malignant potential
Secretes alpha fetoprotein
Describe the sex-chord tumours
Leydig: hormonally active - testosterone and oestrogen
Sertoli cell tumours: rare, don’t produce hormones
Lymphoma - most common tumour >60
Risk factors for Testicular Cancer
Cryptorchidism Gonadal dysgenesis Family history or personal history Testicular atrophy White ethnicity HIV Chemical carcinogens and low sperm count, rural residence, higher socioeconomic status, inguinal hernia, genetic abnormality
Symptoms of Testicular Cancer
Testicular mass (usually unilateral and painless) Non-specific testicular discomfort or heaviness
Symptoms of mets
Leydig:
Testosterone: Premature puberty (young males), Prominent external genitalia, pubic hair growth, accelerated skeletal and muscle development, and mature masculine voice, precocious puberty
Oestrogen: Feminisation, delayed puberty (Young), Gynaecomastia, feminine hair distribution, erectile dysfunction, testicular atrophy, loss of libido
Signs of testicular cancer on examination
Testicular mass (55% on the right | 2% bilateral | Usually painless (>85%) | 10% may present with acute pain | Smooth, painless, hard | NO transillumination
Lymphadenopathy
Gynaecomastia (from Leydig cells tumours)
Hyperthryoidism (hCG subunit similar to TSH)
Investigations for Testicular Cancer
USS with colour Doppler of testis: testicular mass (hypoechoic if seminoma)
Serum beta-hCG: elevated in choriocarcinoma Serum AFP: embryonal, teratoma, yolk sac Serum LDH: elevated Serum alk phos: seminoma Serum GGT: seminoma
CXR: ?mets to lung, mediastinum
CT CAP: enlarged retroperitoneal lymph nodes, staging
