Testicular cancer Flashcards
What are the different types of testicular tumours?
Germ cell tumours - 95% - split further into
- seminomas
- non seminomas
Non germ cell tumours - 5% - normally benign
Which type of testicular tumours are benign and secrete androgens / oestrogens?
non germ cell tumours - sertoli cell and leydig cell tumours
Which type of testicular tumour has the worst prognosis?
Non- seminomatous germ cell tumours
Give some examples of non - seminomatous germ cell tumours?
Teratoma (most common)
Yolk sac tumrous
Choriocarcinoma
Embyronal carcinoma
Why do non - seminomatous germ cell tumours have a worse prognosis?
As the metastasise early
What are some risk factors for testicular cancer?
Cryptorchidism (undescended testes) - germ cell tumours
Family history
Kleinfelter’s syndrome (male with extra X chromosome)
How does testicular cancer present?
Unilateral, painless testicular lump
On examination this mass is irregular, firm, fixed + doesn’t transilluminate
Evidence of metastises - weight loss, back pain etc.
Gynaecomastia can also occur in Leydig cell tumours (as produce oestrogen)
Where is the lymphatic drainage of the testes?
The para-aortic nodes
Why may local lymphadenopathy not be present in testicular cancer in metastatic disease?
As the testes drain to the para-aortic lymph nodes - these are deep + unlikely to be felt
What are differentials for testicular cancer?
Epididymal cyst
Haematoma
Epididymitis
Hydrocoele
What investigations can be done for testicular cancer?
Tumour markers -
- bHCG is raised in 60% of non seminomatous germ cell tumours and some seminomas.
- AFP (alpha ferroprotein) can also be raised
Scrotal ultrasound
Staging with CT imaging of chest/abdo/pelvis
**trans-scrotal percutanous biopsy should not be done as may cause seeding of the cancer
Why is a biopsy not taken for testicular cancer?
As it may cause seeding of the cancer
How is testicular cancer managed?
Surgery - inguinal radical orchidectomy.
Radiotherapy and chemotherapy.
What should be offered to patients of reproductive age prior to management for testicular cancer?
Pre treatment fertility assessment - semen analysis - sperm banking - cryopreservation. As chemo/radiotherapy can impair fertility.
In what age group is testicular cancer most commonly found?
Younger men ages 15-35
