Testicular cancer

Question 1

What cell does testicular cancer arise from?

Answer 1

germ cells

(there are rare non-germ cell tumours and secondary metastases in the testes too)

Question 2

What are germ cells?

Answer 2

Produce gametes

Question 3

What are the 2 types of testicular cancer?

Answer 3

Seminomas
Non-seminomas (mainly teratomas)

Question 4

What is a seminoma?

Answer 4

A malignant germ cell tumour, most commonly involving the testicle. Could be mediastinum, retroperitoneum or other extra-gonadal sites.

Question 5

What is a teratoma?

Answer 5

A rare type of germ cell tumour containing immature or fully formed tissue that is not normally found there. Includes teeth, hair, bones, muscle.

Question 6

Which age group is testicular cancer most common in?

Answer 6

younger men aged 15-35

Question 7

What are risk factors for testicular cancer?

Answer 7

Undescended testes
Male infertility
Family history
Increased height

Question 8

How does testicular cancer present?

Answer 8

Painless lump on testicle, occasionally painful.

Question 9

Describe the lump on the testicle

Answer 9

No transillumination
Non-tender
Hard
Irregular
Not fluctuant

Question 10

Rarely, g______ can be a presentation of testicular cancer, particularly with Leydig cell tumour

Answer 10

gynaecomastia (breast enlargement)

Question 11

What investigations are taken for suspected testicular cancer?

Answer 11

Scrotal USS (first line)

Tumour markers: LDH, Beta-hCG, Alpha-fetoprotein

Staging CT scan to stage and look for areas of spread

Question 12

True or false: the tumour marker alpha-fetoprotein may be raised in pure seminomas

Answer 12

False
May be raised in teratomas, not in pure seminomas

Question 13

What staging is used for testicular cancer?

Answer 13

Royal Marsden Staging system

Question 14

How many stages in Royal Marsden Staging system?

Answer 14

4

Question 15

What is stage 1 of the Royal Marsden staging system?

Answer 15

Isolated to testicle

Question 16

What is stage 2 of the Royal Marsden staging system?

Answer 16

Spread to retroperitoneal lymph nodes

Question 17

What is stage 3 of the Royal Marsden staging system?

Answer 17

Spread to the lymph nodes above the diaphragm

Question 18

What is stage 4 of the Royal Marsden staging system?

Answer 18

Metastasised to other organs

Question 19

Where are common places for testicular cancer to metastasise to?

Answer 19

Lymphatics
Lungs
Liver
Brain

Question 20

How can you manage testicular cancer?

Answer 20

First line = Surgery: radical orchidectomy
(Prosthesis can be inserted)

Chemotherapy
Radiotherapy

Question 21

What must you consider before starting treatment

Answer 21

Sperm banking as risk of infertility.

Question 22

What are long term side effects of treatment for testicular cancer?

Answer 22

Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Kidney damage
Liver damage
Heart damage
Increased risk of future cancer

Question 23

True or false: seminomas have a slightly better prognosis than non-seminomas

Answer 23

True

Question 24

Prognosis for early testicular cancer is good with a greater than __% cure rate

Answer 24

90%

Question 25

After treatment, how are patients followed-up to monitor for recurrence?

Answer 25

Tumour markers
CT scans
Chest XR