Testicular cancer Flashcards
Categories of testicular cancer
- Germ cell tumours - split into seminomas and non-seminomatous, usually malignant
- Non-germ cell tumours usually benign
What usually makes up non-germ cell tumours
- Leydig cell tumour - secrete androgens
- Sertoli cell tumour - secrete oestrogen
- Benign usually
Seminomas prognosis
- Tend to remain localised until late
- Good prognosis
Examples of NSGCT - non seminomatous germ cell tumour
- Yolk sac tumours
- Choriocarcinoma
- Embryonal carcinoma
- Teratoma
Prognosis of non-seminomatous germ cell tumour
- Metastasise early
- Worse prognosis than seminomas
RF for testicular cancer
- Cryptorchidism (undescended teste) - 4-10x increase GCT
- Previous testicular malignancy
- FH
- Caucasian
- Klinefelters syndrome - extra copy X chromosome in males - XXY
Symptoms of testicular cancer
- Unilateral painless testicular lump
- Metastasis - weight loss, back pain (retroperitoneal mets), dyspnoea (lung mets)
Examination of testicular cancer findings
- Irregular, firm, fixed lump
- Does not transilluminate
- Lymphatic drainage is to para-aortic nodes so localised lymphadenopathy may not be present even when metastasied
Differentials for scrotal lump
- Epididymal cyst
- Haematoma
- Epididymitis
- Hydrocele
Bedside and bloods for ?testicular cancer
- Tumour markers - beta-hCG, AFP, LDH
- Scrotal USS
Tumour markers, when they are elevated and used for
- b-HCG - elevated in 60% non-seminomatous germ cell tumours - 100% choriocarcinoma, 5-10% in seminomas
- AFP - raised in some NSGCT, not raised in pure seminomas
- LDH - surrogate marker for tumour volume and necrosis and respond to oncological treatment
Staging of testicular cancer
CT imaging with contrast of chest abdomen pelvis
Biopsy for testicular cancer
SHOULD NOT be performed
Can cause seeding of cancer
Diagnosis made via tumour markers and imaging alone
Staging of testicular cancer - 1-4
Royal Marsden Classfication
* I - confined to testes
* II - infra-diagphragmatic LN involvement
* III - supra and infra diaphragmatic LN involvement
* IV - extralymphatic metastatic spread
Management of testicular cancer
- Surgery
- Radiotherapy
- Chemotherapy
- Choice depends on tumour type, risk scoring and prognosis