Testicular cancer

Question 1

Testicular cancer classification

Answer 1

• germ cell tumours:
• seminomas
• mixed germ cell tumours
• non-seminomas
• non-germ cell tumours:
• Leydig cell tumours
• Sertoli cell tumours
• Granulose cell tumours

Question 2

Testicular cancer risk factors

Answer 2

• cryptorchidism
• previous testicular cancer
• family history of testicular cancer
• subfertility
• Klinefelter syndrome
• Kallman syndrome
• prenatal oestrogen exposure

Question 3

Testicular cancer presentation

Answer 3

• unilateral testicular lump
• irregular, firm and fixed lump
• does not transilluminate
• usually painless, can have dull or acute testicular pain
• metastases - unintentional weight loss, back pain, dyspnoea

Question 4

Testicular lump assessment

Answer 4

• site
• size
• shape
• symmetry
• skin change
• scars

Question 5

Testicular cancer differentials

Answer 5

• epididymo-orchitis
• hydrocele (fluid in tunica vaginalis)
• varicocele (dilated pampiniform veins)
• inguinal hernia

Question 6

Testicular cancer investigations

Answer 6

• tumour markers - beta-HCG, AFP, LDH
• imaging - trans-scrotal ultrasound, CT TAP for staging

Question 7

Testicular cancer management

Answer 7

• discussion in MDT
• radical inguinal orchidectomy including testicle, epididymis and spermatic cord up to inguinal ring
• counsel on sperm banking, cryopreservation
• other options - active surveillance, chemo, radio, retroperitoneal lymph node dissection

Question 8

Testicular cancer complications

Answer 8

• metastasis
• psychosocial impact
• hypogonadism, infertility
• secondary malignancy from treatment
• peripheral neuropathy
• surgical (bleeding, infection)