TESTICULAR CANCER

Question 1

Testicular cancer is most common neoplasm in men aged

Answer 1

20-35

Question 2

what is necessary for diagnosis**

Answer 2

Orchiectomy

Question 3

Pertinent anatomy of a patient with Testicular Mass.

Answer 3

(a) Testicle

(b) Lymph node metastases

Question 4

Signs and symptoms of a patient with Testicular Mass.

Answer 4

(a) Painless enlargement of the testis
1) Patient is usually first to recognize abnormality but delay in seeking medical attention 3-6 months
(b) Sensations of heaviness
(c) Acute testicular pain because of intra- testicular hemorrhage occurs in about 10% of patients
(d) 10% are asymptomatic at presentation
(e) 10% manifest symptoms relating to metastatic disease at presentation
1) Back pain - retroperitoneal metastases
2) Cough - pulmonary metastases
3) Lower extremity edema - vena cava obstruction
(f) Gynecomastia is seen in 5% of patients

Question 5

Differential Diagnosisof a patient with Testicular Mass.

Answer 5

(a) Hydrocele
(b) Epididymo-orchitis
(c) Lymphoma of testis
(d) Metastases to the testis
(e) Epidermoid cyst
(f) An incorrect diagnosis is made at the initial examination in up to 25% of patients with testicular tumors

Question 6

Laboratory orders

Answer 6

1) Human chorionic gonadotropin (hCG)

Question 7

If you are suspecting testicular cancer, what labs should you order**

Answer 7

HCG.

It’ll come back positive.

Question 8

Imaging

Answer 8

(a) Scrotal ultrasound
1) Determine if mass is intra- testicular or extra testicular
(b) Clinical staging (once diagnosis is made)
1) Chest, abdominal, and pelvic CT scanning

Question 9

Treatment

Answer 9

(a) Diagnosis is made by inguinal orchiectomy
1) Up to 75% Diagnosis is made by inguinal orchiectomy
(b) Cancers with retroperitoneal disease are treated with radical orchiectomy and retroperitoneal irradiation
(c) More advanced cancers require chemotherapy

Question 10

Complications

Answer 10

(a) 5-year disease free survival for patients with stage I-III are between 90-100% depending on staging.
(b) Patients with disseminated disease have a 5-year disease free survival rate of 55-80%

Question 11

)Follow up

Answer 11

(a) Refer all patients with solid masses of the testis to a Urologist
(b) Oncology
1) If metastatic disease is suspected.