testicular cancer

Question 1

arises from

Answer 1

germ cells in testes

Question 2

most common in

Answer 2

younger men - peak incidence 15-35yrs

Question 3

two types

Answer 3

seminomas

non-seminomas (mostly teratomas)

Question 4

risk factors

Answer 4

undescended testes
male infertility
FHx
increased height

Question 5

typical presentation

Answer 5

painless testicular lump

Question 6

OE - lump will be

Answer 6

non-tender
arising from testicle
hard
irregular
non-fluctuant
no transillumination

Question 7

gynaecomastia and testicular cancer

Answer 7

rarely gynaecomastia can be presentation of testicular cancer

esp leydig tumour

Question 8

Ix

Answer 8

scrotal USS initial Ix

tumour markers
staging CT

Question 9

tumour markers

Answer 9

alpha-fetoprotein (teratomas)
beta-hCG
LDH

Question 10

staging system

Answer 10

royal marsden staging system

Question 11

stage 1

Answer 11

isolated to testicle

Question 12

stage 2

Answer 12

retroperitoneal nodes

Question 13

stage 3

Answer 13

nodes above diaphragm

Question 14

stage 4

Answer 14

metastases to other organs

Question 15

common places for metastases

Answer 15

lymphatics
lung
liver
brain

Question 16

Mx can involve

Answer 16

surgery - radical orchidectomy
chemotherapy
radiotherapy
sperm banking

guided by MDT

Question 17

side effects of treatment

Answer 17

infertility 
hypogonadism 
peripheral neuropathy 
hearing loss
lasting kidney, liver, heart damage
inc risk future cancer

Question 18

prognosis

Answer 18

90% cure rate

metastatic disease often curable

seminomas slightly better prognosis than non-seminomas

Question 19

follow up

Answer 19

follow up to monitor for recurrence

• tumour markers
• CXR, CT scans