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Urology YR3 > Testicular cancer > Flashcards

Testicular cancer Flashcards

1
Q

Categories of testicular cancer

A
  • Germ cell tumours - split into seminomas and non-seminomatous, usually malignant
  • Non-germ cell tumours usually benign
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2
Q

What usually makes up non-germ cell tumours

A
  • Leydig cell tumour - secrete androgens
  • Sertoli cell tumour - secrete oestrogen
  • Benign usually
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3
Q

Seminomas prognosis

A
  • Tend to remain localised until late
  • Good prognosis
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4
Q

Examples of NSGCT - non seminomatous germ cell tumour

A
  • Yolk sac tumours
  • Choriocarcinoma
  • Embryonal carcinoma
  • Teratoma
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5
Q

Prognosis of non-seminomatous germ cell tumour

A
  • Metastasise early
  • Worse prognosis than seminomas
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6
Q

RF for testicular cancer

A
  • Cryptorchidism (undescended teste) - 4-10x increase GCT
  • Previous testicular malignancy
  • FH
  • Caucasian
  • Klinefelters syndrome - extra copy X chromosome in males - XXY
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7
Q

Symptoms of testicular cancer

A
  • Unilateral painless testicular lump
  • Metastasis - weight loss, back pain (retroperitoneal mets), dyspnoea (lung mets)
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8
Q

Examination of testicular cancer findings

A
  • Irregular, firm, fixed lump
  • Does not transilluminate
  • Lymphatic drainage is to para-aortic nodes so localised lymphadenopathy may not be present even when metastasied
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9
Q

Differentials for scrotal lump

A
  • Epididymal cyst
  • Haematoma
  • Epididymitis
  • Hydrocele
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10
Q

Bedside and bloods for ?testicular cancer

A
  • Tumour markers - beta-hCG, AFP, LDH
  • Scrotal USS
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11
Q

Tumour markers, when they are elevated and used for

A
  • 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
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12
Q

Staging of testicular cancer

A

CT imaging with contrast of chest abdomen pelvis

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13
Q

Biopsy for testicular cancer

A

SHOULD NOT be performed
Can cause seeding of cancer
Diagnosis made via tumour markers and imaging alone

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14
Q

Staging of testicular cancer - 1-4

A

Royal Marsden Classfication
* I - confined to testes
* II - infra-diagphragmatic LN involvement
* III - supra and infra diaphragmatic LN involvement
* IV - extralymphatic metastatic spread

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15
Q

Management of testicular cancer

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Choice depends on tumour type, risk scoring and prognosis
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16
Q

Surgical option for testicular cancer

A
  • Inguinal radical orchidectomy
  • Inguinal approach allows for limited lymphatic disruption - important in malignancy
  • Tumour bearing testicle is removed with epididymis, spermatic fascia and cord
17
Q

What can be performed at same time inguinal radical orchidectomy?

A
  • Biopsy of contralateral testicle in patients <40 and volume of contralateral testes is <12ml
  • OR history of cryptochidism
  • OR subfertility
18
Q

Consequences of testicular cancer treatment and what needs to be done because of this

A
  • Impaired fertility - sperm abnormalities and leydig cell dysfunction found prior to orchidectomy anyway already
  • Further treatments eg chemo and radiotherapy impair even move
  • Pre-treatment fertility assessment should be done, semen analysis and cryopreservation offered to all patients
19
Q

Management of non-seminomatous germ cell tumours - localised

A
  • Stage 1 - orchidectomy then managed re risk
  • Low risk if no evidence of vascular invasion - surveillance
  • High risk or those with vascular invasion adjuvant chemo and surveillance
20
Q

What does surveillance involve for NSGCT?

A
  • Regular examination
  • Surveillance CT imaging
  • CXRs
  • Tumour markers
21
Q

Management of seminomas - stage 1

A
  • Orchidectomy alone then surveillance
  • If high risk relapse - adjuvant chemotherapy
  • High risk relapse features on histology = invasion of rete testis and tumour size >4cm
22
Q

Management of metastatis NSGCT

A
  • Dependent on risk scoring
  • Intermediate prognosis - chemotherapy
  • Poor prognosis - one cycle of chemotherapy before reassessment (if decline in tumour markers continue chemo, if unfavourable, intensify chemo)
23
Q

Surveillance for stage 1 seminoma after orchidectomy

A

Twice yearly
* Examination
* Surveillance CT
* Tumour markers
* Beyound 5 years, surveillance transferred to GP with examination and tumour markers alone

24
Q

Management of metastatic seminomas

A
  • IIA - radiotherapy or chemotherapy
  • Higher stage will require chemotherapy alone and treated similar to NSGCT ie based on prognosis and whether to increase chemo intensity based on response
25
Q

Complications of testicular cancer

A
  • Increased risk of secondary malignancies eg leukaemia - if undergoing radiotherapy and chemotherapy

Urology YR3 (27 decks)

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