Testicular Cancer

Question 1

Definition of testicular cancer

Answer 1

A malignant tumour of the testes. Commonest malignancy found in young adult men (20-34)

Question 2

Aetiology of testicular cancer

Answer 2

• The majority of testicular cancers are germ cell tumours, divided into:
◦ Seminoma (more common)
◦ Non-Seminoma

Question 3

Risk factors for testicular cancer

Answer 3

• Cryptorchidism (undescended testes)
• Genetic predisposition/ Family history
• Trauma
• Atrophic testes
• Previous testicular cancer
• Klinefelters syndrome

Question 4

Pathophysiology of testicular cancer

Answer 4

• Carcinoma in situ would become malignant as soon as it grows beyond the basement membrane, would eventually replace all the testicular parenchyma
• Lymphatic spread can occur through the spermatic cord lymphatics

Question 5

History and Examination of testicular cancer

Answer 5

Testicular mass:
◦ Painless (usually)
◦ Hard mass
◦ Unlikely bilateral
◦ Presents as swelling and discomfort usually
◦ Likely to be smooth
◦ Does not transluminate with light
• Lymphadenopathy: may have spread to supraclavicular lymph nodes etc
• Usually >2 weeks symptoms onset
• May have gynaecomastia: can be due to Leydig cell tumours (non-germ cell)

Question 6

Investigations for testicular cancer

Answer 6

• ULTRASOUND with colour Doppler of testis: First line test. Used to confirm presence of testicular mass
• CXR, CT abdo+pelvis: for staging of cancer
• Tumour markers, would be elevated in specific cases:
◦ Beta-hCG
◦ Alpha-FP (AFP)
◦ Serum LDH

Question 7

Treatment for testicular cancer

Answer 7

1) Radical inguinal orchidectomy:
◦ Should occlude the spermatic cord first to reduce risk of cancer spread. Then remove affected testicle and spermatic cord
◦ Side effect of reduced fertility

+ post-orchidectomy chemo/radiotherapy: good for reducing the risk of relapse

+ Close surveillance post surgery to see if relapse (follow tumour markers)

Question 8

Prevention and prognosis of testicular cancer

Answer 8

• Self examination can reduce late presentation of lump

Appropriate treatment allows the majority of cases to be cured
Very good progress if metastatic cancer is detected early (with combination chemotherapy)

Question 9

Complications of testicular cancer

Answer 9

• Infertility: due to treatment
• Treatment related side effects: nausea, kidney injury etc