Testicular Cancer Flashcards
… cancer is responsible for 1% of all new cancers in men.
Testicular cancer is responsible for 1% of all new cancers in men.
Testicular cancer is responsible for ….% of all new cancers in men.
Testicular cancer is responsible for 1% of all new cancers in men.
Testicular cancer typically presents with a unilateral testicular mass. Incidence appears to be increasing, with approximately 3-10 cases / 100,000 men each year in the Western world.
Testicular cancer typically presents with a unilateral testicular mass. Incidence appears to be increasing, with approximately 3-10 cases / 100,000 men each year in the Western world.
The vast majority of testicular cancers are …
The vast majority of testicular cancers are germ-cell tumours (95%). Overall prognosis, following appropriate therapy, is good.
Incidence of testicular cancer - when is the peak age?
Incidence rises in adolescence, peaks between the ages of 30-34, before falling significantly over the subsequent decades. There is a small rise in incidence over the age of 90.
There are a number of risk factors associated with testicular cancer (5)
Cryptorchidism Hypospadias Infertility Klinefelter’s syndrome Tall men
Testicular germ cell tumours can be classified as …. and …-… germ cell tumours.
Testicular germ cell tumours can be classified as seminoma and non-seminomatous germ cell tumours.
The vast majority of testicular tumours are … … in origin (95%).
The vast majority of testicular tumours are germ cell in origin (95%). The two major types are seminoma and non-seminomatous germ cell tumours. Other tumour types are also seen, but these are far less common.
Germ cell tumours types
Seminoma Non-seminomatous germ cell tumours (NSGCT): - Embryonal carcinoma - Yolk sac tumour - Choriocarcinoma - Teratoma Mixed
Sex cord/gonadal stromal tumours - types
Leydig cell tumour
Sertoli cell tumour
Granulosa cell tumour
Thecoma/fibroma group of tumours
Testicular cancer most commonly presents with a … … mass.
Testicular cancer most commonly presents with a unilateral scrotal mass.
Clinical features are typically scrotal, but systemic features may be seen:
Testicular … Testicular …/… … pain, … pain (indicative of …) ….denopathy …. (more common in NSGCT)
Cases of suspected testicular cancer should be referred urgently via a … week wait pathway
Cases of suspected testicular cancer should be referred urgently via a two-week wait pathway.
NICE NG 12 recommends referring all men with … … or change in size or change in texture via a two-week wait pathway to urology. Additionally refer patients describing a dragging sensation, new varicocele or hydrocele.
NICE NG 12 recommends referring all men with non-painful testicular enlargement or change in size or change in texture via a two-week wait pathway to urology. Additionally refer patients describing a dragging sensation, new varicocele or hydrocele.
Suspect testicular cancer in patients with unexplained retroperitoneal masses or suspected … on imaging. Also suspect in men presenting with infertility or with elevated AFP / ….
Suspect testicular cancer in patients with unexplained retroperitoneal masses or suspected metastasis on imaging. Also suspect in men presenting with infertility or with elevated AFP / hCG.
Testicular … is the diagnostic modality of choice for testicular cancer
Testicular USS is the diagnostic modality of choice for testicular cancer
USS offers excellent visualisation and identifies likely malignant lesions (the diagnosis is confirmed with histology following an …). Its sensitivity approaches 100% in trained hands.
USS offers excellent visualisation and identifies likely malignant lesions (the diagnosis is confirmed with histology following an orchidectomy). Its sensitivity approaches 100% in trained hands.
Bloods before an orchidectomy
- FBC
- Renal function
- LFT
Imaging before testicular cancer diagnosis
CXR: may identify pulmonary metastasis.
In testicular cancer, tumour markers may be measured to support the diagnosis and offer prognostic information. However, normal levels do not exclude cancer and levels may be elevated in other pathologies. The three major markers are:
Alpha-fetoprotein (AFP): may be seen in NSGCT, particularly the yolk sac subtype. AFP is not seen in pure seminoma. Beta-human chorionic gonadotrophin (beta-hCG): may be seen in NSGCT, particularly the choriocarcinoma subtype. Can also be seen in seminomas. Lactate dehydrogenase (LDH): general marker of increased cell turnover, may be raised in either seminomas or NSGCTs.
Placental alkaline phosphatase may also be measured and is indicative of … (testicular cancer)
Placental alkaline phosphatase may also be measured and is indicative of seminoma.
… should be discussed with patients prior orchidectomy.
Fertility should be discussed with patients prior orchidectomy.
Testicular cancer two types
Seminomas
Non-seminomas (mostly teratomas)
Risk Factors for testicular cancer (4)
Undescended testes
Male infertility
Family history
Increased height
Testicular cancer
The typical presentation is a painless lump on the testicle. Occasionally it can present with testicular pain.
The lump will be:
Non-tender (or even reduced sensation) Arising from testicle Hard Irregular Not fluctuant No transillumination
Rarely, gynaecomastia (breast enlargement) can be a presentation of testicular cancer, particularly a rare type of tumour called a … cell tumour. About 2% of patients presenting with gynaecomastia have a testicular tumour.
Rarely, gynaecomastia (breast enlargement) can be a presentation of testicular cancer, particularly a rare type of tumour called a Leydig cell tumour. About 2% of patients presenting with gynaecomastia have a testicular tumour.
Scrotal ultrasound is the usual initial investigation to confirm the diagnosis.
Tumour markers for testicular cancer are:
Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas) Beta-hCG – may be raised in both teratomas and seminomas Lactate dehydrogenase (LDH) is a very non-specific tumour marker
Testicular cancer is staged with the Royal Marsden staging system:
Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs
The common places for testicular cancer to metastasise to are:
Lymphatics
Lungs
Liver
Brain
Management of any cancer is guided by a multidisciplinary team (MDT) meeting to decide the best course of action for the individual patient.
Depending on the grade and stage of testicular cancer, treatment can involve:
Surgery to remove the affected testicle (radical orchidectomy) – a prosthesis can be inserted
Chemotherapy
Radiotherapy
Sperm banking to save sperm for future use, as treatment may cause infertility
Long term side effects of treatment are particularly significant, as most patients are young and expected to live many years after treatment of testicular cancer. Side effects include:
Infertility Hypogonadism (testosterone replacement may be required) Peripheral neuropathy Hearing loss Lasting kidney, liver or heart damage Increased risk of cancer in the future
The prognosis for early testicular cancer is…
The prognosis for early testicular cancer is good, with a greater than 90% cure rate. Metastatic disease is also often curable. Seminomas have a slightly better prognosis than non-seminomas.
Patients will require follow-up to monitor for reoccurrence. This usually involves monitoring tumour markers, and may include imaging such as CT scans or chest x-rays.
Seminomas vs non seminomas - which has a better prognosis
Seminomas have a slightly better prognosis than non-seminomas.
Common pulmonary manifestation of metastatic choriocarcinoma on imaging is … metastases.
Common pulmonary manifestation of metastatic choriocarcinoma on imaging is cannonball metastases. They typically appear as multiple round well-defined pulmonary nodules representing hematological spread of the malignancy.
