Testicular Cancer Flashcards
Which age group is testicular cancer most common in?
20-40 yrs
What are primary testicular tumours categories into?
Germ cell tumour (95%)
Non-germ cell tumors (5%) (NGCTs)
Germ cell, Sub-classified into:
Seminomas
Non-seminomatoues GCTS (NSGCT)
Usually malignant
What are features of NGCTs?
Usually bengin comprising of ethier Leydig cell tumours or Sertoli cell tumours. ( secrete androgens and oestrogens)
What are the features of seminomas?
Remain loaclised until late and have very good prognosis.
What do NSGCTs include?
yolk sac tumours, choriocarcinoma, embryonal carcinoma, and teratoma;
NSGCTs often metastasise early and have worse prognosis than seminomas.
What are the risk factors for testicular tumours?
Cryptorchidism
previous testicular malignancy,
a positive family history,
Kleinfelter’s syndrome.
What are the clinical features of tesicular cancers?
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).
What are the diffrential diagnosis of testicular cancers?
epididymal cyst,
haematoma,
epididymitis,
hydrocoele.
What tumour markers for testicular cancers?
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
What investogations other then tumour markers can you do for testicular cancer?
Scrotal ultrasound
Staging CT with contrast
Do not take biopsy - as causes seeding of cancer.
What is the staging of testicular cancer?
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
What is the general managemnet of testicular cancer?
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.
How are most cases that are sutible for surgery in testicular cancer treated?
inguinal radical orchidectomy - remove epididymis, spermatic fascia and cord.
What is commonly found prior to orchiectomy of testicular cancer?
Sperm abnormalities
Ledig cell dysfunction
What should be done in patinets of reproductive age before treatment?
Pre-treatment fertility assessment - semen analysis and cryopreservation offered.
What is the management of stage 1 NSGCTs?
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.
What is the management of metastaic NSGCTs?
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).
What is managemet of stage 1 seminomas?
orchidectomy alone and surveillance monitoring. Patients have a high relapse risk are often considered for chemotherapy
What is the management of metastatic seminoma?
stage IIA can be treated with either radiotherapy or chemotherapy, whilst higher stage disease will require primary chemotherapy and treated similar to metastatic NSGCTs
What are the complications of radiotherapy and chemotherpay?
risk of secondary malignancies, such as leukaemia.
