Testicular Cancer

Question 1

Which age group is testicular cancer most common in?

Answer 1

20-40 yrs

Question 2

What are primary testicular tumours categories into?

Answer 2

Germ cell tumour (95%)
Non-germ cell tumors (5%) (NGCTs)

Germ cell, Sub-classified into:
Seminomas
Non-seminomatoues GCTS (NSGCT)

Usually malignant

Question 3

What are features of NGCTs?

Answer 3

Usually bengin comprising of ethier Leydig cell tumours or Sertoli cell tumours. ( secrete androgens and oestrogens)

Question 4

What are the features of seminomas?

Answer 4

Remain loaclised until late and have very good prognosis.

Question 5

What do NSGCTs include?

Answer 5

yolk sac tumours, choriocarcinoma, embryonal carcinoma, and teratoma;

NSGCTs often metastasise early and have worse prognosis than seminomas.

Question 6

What are the risk factors for testicular tumours?

Answer 6

Cryptorchidism

previous testicular malignancy,

a positive family history,

Kleinfelter’s syndrome.

Question 7

What are the clinical features of tesicular cancers?

Answer 7

unilateral painless testicular lump.

On examination, the mass is typically irregular, firm, fixed, and does not transilluminate.

Evidence of metastasis may present with weight loss, back pain (from retroperitoneal metastases), or dyspnoea (secondary to lung metastases).

Question 8

What are the diffrential diagnosis of testicular cancers?

Answer 8

epididymal cyst,
haematoma,
epididymitis,
hydrocoele.

Question 9

What tumour markers for testicular cancers?

Answer 9

both diagnostic and prognostic means.

Beta-HCG: high in 60% of NSGCTs, 10% of Seminomas

AFP: Specfic to NSGCTs, not always raised

LDH: tumour volume and necrosis+ treatment response

Question 10

What investogations other then tumour markers can you do for testicular cancer?

Answer 10

Scrotal ultrasound

Staging CT with contrast

Do not take biopsy - as causes seeding of cancer.

Question 11

What is the staging of testicular cancer?

Answer 11

Royal marsden classification

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

What is the general managemnet of testicular cancer?

Answer 12

All patients with confirmed testicular cancer he should be discussed in a specialist MDT. The main treatment options for testicular cancer are surgery, radiotherapy, and chemotherapy; the treatment of choice depends on the tumour type, risk scoring, and prognosis.

Question 13

How are most cases that are sutible for surgery in testicular cancer treated?

Answer 13

inguinal radical orchidectomy - remove epididymis, spermatic fascia and cord.

Question 14

What is commonly found prior to orchiectomy of testicular cancer?

Answer 14

Sperm abnormalities

Ledig cell dysfunction

Question 15

What should be done in patinets of reproductive age before treatment?

Answer 15

Pre-treatment fertility assessment - semen analysis and cryopreservation offered.

Question 16

What is the management of stage 1 NSGCTs?

Answer 16

Orchidectomy - further managemnet depends on risk score.

Low risk - surveillance
High risk - adjuvant chemotherapy and then surveillance, including CT scan at 3 and 12 months.

Question 17

What is the management of metastaic NSGCTs?

Answer 17

intermediate prognosis should be treated with cycles of chemotherapy

those with poor prognosis should be treated with one cycle of chemotherapy before reassessment (those with marker decline should have continued chemotherapy cycles, whilst those with unfavourable decline should have their chemotherapy intensified).

Question 18

What is managemet of stage 1 seminomas?

Answer 18

orchidectomy alone and surveillance monitoring. Patients have a high relapse risk are often considered for chemotherapy

Question 19

What is the management of metastatic seminoma?

Answer 19

stage IIA can be treated with either radiotherapy or chemotherapy, whilst higher stage disease will require primary chemotherapy and treated similar to metastatic NSGCTs

Question 20

What are the complications of radiotherapy and chemotherpay?

Answer 20

risk of secondary malignancies, such as leukaemia.