Testicular Cancer

Question 1

What is the most common cancer in male age 20-40?

Answer 1

• testicular cancer

Question 2

What are the types of TC?

Answer 2

• Germ Cell Tumour (GCT) 95%
  
  • seminomas (SGCT)
  • non-seminomatous (NSGCT) - usually malignant
    
    • yolk sac tumors
    • choriocarcinoma
    • embryonal carcinoma
    • teratoma
• Non Germ Cell Tumour (NGCT)
  
  • leydig cell tumour
  • sertoli cell tumour
  • granulosa cell tumour

Question 3

What are the RF for TC?

Answer 3

• Cryptorchidism
• previous testicular malignancy
• positive family history
• Kleinfelter’s syndrome
• Hypospadias

Question 4

What are the clinical features of TC?

Answer 4

• unilateral painless testicular lump
  
  • irregular, firm, fixed, and does not transilluminate
• Testicular pain/discomfort
• Back pain, flank pain (indicative of metastasis)
• Lymphadenopathy
• Gynaecomastia (more common in NSGCT)

Signs of metastases

• weight loss
• back pain
• dyspnoea - lung cancer

Question 5

Why lymphadenopathy may not be present in TC?

Answer 5

• lymphatic drainage of testes is to para-aortic LN

Question 6

What are the criterias for 2WW referral for suspected TC?

Answer 6

• all men with
  
  • non-painful testicular enlargement
  • change in size
  • change in texture
• Additional criterias
  
  • dragging sensation
  • new varicocele
  • hydrocele

Question 7

What are the differential diagnosis for TC?

*think what causes scrotal lump

Answer 7

• epididymal cyst
• haematoma
• epididymitis
• hydrocoele.

Question 8

What Ix would you order for TC?

Answer 8

• Testicular USS - initial assessment & modality of choice
• Bloods
  
  • bHCG - raised in NSGCT
  • AFP - raised in NSGCT
  • LDH
• CT c contrast - stage the disease

Question 9

Why is biopsy avoided in TC?

Answer 9

• can cause seeding of cancer

Question 10

What are the 2 classifications used in TC?

Answer 10

• Royal Marsden Hospital (RMH) Staging Classification
• International Germ Cell Consensus Classification system (IGCCC)

Question 11

Briefly describe the RMH staging

Answer 11

• I: Disease confined to testes
• II: Infra-diaphragmatic lymph node involvement
• III: Supra- and infra-diaphragmatic lymph node involvement
• IV: Extralymphatic metastatic spread

Question 12

How would you mx NSGCT?

Answer 12

Stage 1

• orchidectomy
  
  • surveillance if low risk
  • chemo(cisplatin, etoposide, bleomycin) + surveillance if high risk

Metastatic

• adjuvant bleomycin, etoposide and cisplatin (BEP) chemotherapy.

Question 13

How would you mx seminomas?

Answer 13

Stage 1

• orchidectomy, surveillance monitoring
• chemotherapy

metastatic seminoma

• stage 2: radiotherapy or chemotherapy,
• Higher: primary chemotherapy and treated similar to metastatic NSGCTs

Question 14

What should you assess pre Mx for TC?

Answer 14

• pre-treatment fertility assessment
• semen analysis
• offer cryopreservation

Question 15

What are the Cx of TC?

Answer 15

• risk of secondary malignancies - leukaemia
  *