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Adult Health Issues + Men's Health > Testicular Cancer > Flashcards

Testicular Cancer Flashcards

1
Q

testicular cancer is __ most common cancer in young men aged 20-39

A

2nd

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2
Q

70% are diagnosed with stage _ disease which is _____ disease

A

1 - early disease

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3
Q

cure rate of testicular cancer is >x%

A

> 95%

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4
Q

cure rate of testicular cancer is high due to the extremely high ______ and _____ sensitivity of this cancer

A
  • chemotherapy
  • radiotherapy
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5
Q

pathogenesis of testicular cancer

A
  • cause not understood yet
  • but since cancer = acquired genetic mutation throughout life
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6
Q

different types of testicular tumours (3)

A
  • germ cell tumours
  • sex cord stromal tumours
  • non-specific stromal tumours
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7
Q

subcategories (2) of germ cell tumours

A
  • seminomas
  • non-seminomas
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8
Q

risk factors of testicular cancer

A
  • cryptorchidism
  • family history
  • personal history
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9
Q

what is cryptorchidism and what is at higher risk of testicular cancer

A

condition where one or both testes fail to descend from abdomen into scrotum

teste that didn’t descend at higher risk

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10
Q

history of testicular lump

A
  • lump: when got, size, tenderness, unilateral vs bilateral
  • scrotal trauma?
  • pain?
  • history of fertility issues
  • history of cryptorchidism
  • sexual history
  • associated symptoms
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11
Q

how can testicular cancer be linked to fertility issues

A
  • teste that is affected by cancer has lower sperm production than normal teste
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12
Q

testicular lump examination

A
  • consent and chaperone

Inspection
- penis, groin, abdomen
> skin changes - bruising, swelling, warts, erythema
> scars
> masses - inguinal region (inguinal hernia, lymphadenopathy), penis

  • scrotum, perineum
    > skin changes - bruising, swelling, warts, erythema
    > scars - possible previous surgery (vasectomy, orchoidpexy)
    > masses

Palpation
- penis
> retract foreskin if uncircumcised
> inspect glans for abnormalities with foreskin retracted
> replace foreskin
- testicles
> between thumb and index finger palpate teste
> size and consistency
> if unable to locate, follow along path of inguinal ligament for undescended teste
- scrotal mass
> size, shape, consistency, tenderness, fluctuance, transillumination (red colour when shine torch), cough impulse (if is, may be hernia), ability to get above the lump (can’t do if hernia)
- epididymis
- spermatic cord
- inguinal lymph nodes (see if any spread)
- Preh’s test
- Cremasteric reflex

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13
Q

testicular lump differentials (4) other than testicular cancer

A
  • epididymal cysts
  • spermatocele
  • hyatid of Morgagni
  • hydrocele (may be a warning sign)
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14
Q

what is the Preh’s test

A

for patients with testicular pain
- if elevate testicles & pain improves
-> suggest epididymitis (inflammation of epididymis - duct behind testis)

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15
Q

what is Cremasteric reflex

A
  • inner part of thigh is stroked
  • should cause contraction of cremaster muscle on same side
  • if absent in adult, then there might be testicular torsion
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16
Q

testicular lump - investogations

A
  • urgent US scrotum (1-2 days of presentation) - do not biopsy lump
17
Q

why is biopsing not done with testicular cancer

A

act of biopsying in testicular cancer has high risk of seeding cancer and spreading it

18
Q

testicular lump - investigations after US

A

if US suggestive of testicular cancer
- referral to urologist
- CT chest, abdo, pelvis - looking for spread of disease
- serum tumour markers

19
Q

what are the relevant serum tumour markers in testicular cancer investigation

A
  • alpha fetoprotein
  • hCG
  • LDH
20
Q

management of testicular cancer

A
  • urgent referral to specialist urologist (they arrange surgery)

decision to remove testes based on suspicion on US
- initial management is orchidectomy (removal of teste/s, tunica albuginiea (touch outer layer of testicle) , spermatic cord) -> these are sent off to pathology for analysis & final diagnosis

  • adjuvant therapy (multidisciplinary meeting to decide if needed)
  • testicular prosthesis (discussion if patient wants)
21
Q

what is adjuvant therapy

A
  • cancer treatment given after primary treatments (eg/ surgery) to lower chance of cancer recurrence
  • can include chemotherapy, radiotherapy, hormone therapy, etc
22
Q

adjuvant therapy in early and advanced disease

A

early stage disease - can often be followed by active surveillance; may be followed by chemotherapy or radiotherapy

if patient has relapse or advanced stage disease - will have chemotherapy after orchidectomy

23
Q

testicular cancer - management

A
  • psychological support (esp imp since many patients are young; traumatic to them and their family) - offer regular support, contacts, referral to psychologist if needed
  • fertility
  • follow up (regular testing of tumour markers, history, examination, possible imaging - usually in consultation with specialist; monitoring for relapse, also risk of new testicular cancer in remaining testis that needs to be monitored)
24
Q

for management of testicular cancer, describe fertility management

A
  • discussion about the consideration of semen storage, esp if they want kids in future
  • patients with testicular cancer often have low or absent sperm production before treatment (can do pre-treatment semen analysis)
  • which can be further impacted by chemotherapy or radiotherapy so may want to consider semen storage before treatments
  • orchidectomy does not affect sperm-producing ability of remaining testis
25
Q

in testicular cancer, usually spreads where

A
  • lymph nodes, lungs
26
Q

in testicular cancer what imaging is good for looking at testes

A

US

27
Q

in testicular cancer what is good for looking at spread

A

CT

Adult Health Issues + Men's Health (4 decks)

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