Testicular cancer

Question 1

What is testicular cancer?

Answer 1

Malignant tumour of the testes 

Question 2

What are the different types of testicular cancer a patient may have?

Answer 2

a) Germ cell tumours: 
1. Seminomas - 50% (‘cut potato’ like appearance, spread in lymphatics) 
2. Non-seminomas (NSGCT): 
- teratomas - 30% (variegated/ multicoloured gross appearance: solid & cystic areas, spread in blood stream) 
- Choriocarcinomas 
- Yolk sac carcinoma 
- Embryonal carcinoma 

b) Non-germ cell tumours: 
1. RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) 
2. Non-Hodgkin’s lymphoma (rare, occur mainly in elderly) 

Question 3

What causes testicular cancer?

Answer 3

UNKNOWN

Question 4

What are the risk factors for testicular cancer?

Answer 4

• Maldescended testes
• Ectopic testes – testes ended up in unknown location
• Atrophic tests – reduced in size
• Cryptorchidism (undescended testes)
• infertility
• age <45
• positive family history
• hx testicular cancer

Question 5

Summarise the epidemiology of testicular cancer

Answer 5

• UNCOMMON 
• 1% of male malignancies 
• Common age of onset: 18-35 yrs (it is the most common - malignancy in men aged 20-30) 
• Teratomas - 20-35 years 
• Seminomas - 35-45 years

Question 6

What are the presenting symptoms of testicular cancer?

Answer 6

● Swelling or discomfort of the testes
● Backache due to para-aortic lymph node enlargement
● Lung metastases –> SOB, haemoptysis

Question 7

What signs of testicular cancer can be found on physical examination?

Answer 7

● Painless, hard testicular mass
● There may be a secondary hydrocoele (swelling in the scrotum)
● Lymphadenopathy (e.g. supraclavicular, para-aortic)
● Gynaecomastia (tumour produces hCG)

Question 8

What investigations are used to diagnose/ monitor testicular cancer?

Answer 8

1. Ultrasound with colour doppler of testis → 1st line principal test which shows testicular mass
2. Tumour Markers → alpha fetoprotein (AFP - only in non-seminoma), beta-hCG, LDH
   - Seminoma = normal AFP, raised beta-hCG and LDH
   - Non-Seminoma Germ Cell = raised AFP and beta-hCG
   AFP → normal in seminoma, raised in teratoma
3. CXR and CTAP → look for metastatic spread (for staging).

Question 9

How is testicular cancer managed?

Answer 9

1. Prior to surgery → sperm cryopreservation (tumours associated with decreased fertility)
2. Surgical Removal → Radical Inguinal Orchidectomy
3. Radiotherapy & Chemotherapy

Question 10

What complications may arise following testicular cancer?

Answer 10

Infertility

Question 11

Summarise the prognosis of testicular cancer

Answer 11

Excellent prognosis, with high cure rate and 5 year survival rates of >95%