Testicular cancer Flashcards
What cell does testicular cancer arise from?
germ cells
(there are rare non-germ cell tumours and secondary metastases in the testes too)
What are germ cells?
Produce gametes
What are the 2 types of testicular cancer?
Seminomas
Non-seminomas (mainly teratomas)
What is a seminoma?
A malignant germ cell tumour, most commonly involving the testicle. Could be mediastinum, retroperitoneum or other extra-gonadal sites.
What is a teratoma?
A rare type of germ cell tumour containing immature or fully formed tissue that is not normally found there. Includes teeth, hair, bones, muscle.
Which age group is testicular cancer most common in?
younger men aged 15-35
What are risk factors for testicular cancer?
Undescended testes
Male infertility
Family history
Increased height
How does testicular cancer present?
Painless lump on testicle, occasionally painful.
Describe the lump on the testicle
No transillumination
Non-tender
Hard
Irregular
Not fluctuant
Rarely, g______ can be a presentation of testicular cancer, particularly with Leydig cell tumour
gynaecomastia (breast enlargement)
What investigations are taken for suspected testicular cancer?
Scrotal USS (first line)
Tumour markers: LDH, Beta-hCG, Alpha-fetoprotein
Staging CT scan to stage and look for areas of spread
True or false: the tumour marker alpha-fetoprotein may be raised in pure seminomas
False
May be raised in teratomas, not in pure seminomas
What staging is used for testicular cancer?
Royal Marsden Staging system
How many stages in Royal Marsden Staging system?
4
What is stage 1 of the Royal Marsden staging system?
Isolated to testicle
What is stage 2 of the Royal Marsden staging system?
Spread to retroperitoneal lymph nodes
What is stage 3 of the Royal Marsden staging system?
Spread to the lymph nodes above the diaphragm
What is stage 4 of the Royal Marsden staging system?
Metastasised to other organs
Where are common places for testicular cancer to metastasise to?
Lymphatics
Lungs
Liver
Brain
How can you manage testicular cancer?
First line = Surgery: radical orchidectomy
(Prosthesis can be inserted)
Chemotherapy
Radiotherapy
What must you consider before starting treatment
Sperm banking as risk of infertility.
What are long term side effects of treatment for testicular cancer?
Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Kidney damage
Liver damage
Heart damage
Increased risk of future cancer
True or false: seminomas have a slightly better prognosis than non-seminomas
True
Prognosis for early testicular cancer is good with a greater than __% cure rate
90%
After treatment, how are patients followed-up to monitor for recurrence?
Tumour markers
CT scans
Chest XR
