Testicular Cancer Flashcards
testicular cancer is __ most common cancer in young men aged 20-39
2nd
70% are diagnosed with stage _ disease which is _____ disease
1 - early disease
cure rate of testicular cancer is >x%
> 95%
cure rate of testicular cancer is high due to the extremely high ______ and _____ sensitivity of this cancer
- chemotherapy
- radiotherapy
pathogenesis of testicular cancer
- cause not understood yet
- but since cancer = acquired genetic mutation throughout life
different types of testicular tumours (3)
- germ cell tumours
- sex cord stromal tumours
- non-specific stromal tumours
subcategories (2) of germ cell tumours
- seminomas
- non-seminomas
risk factors of testicular cancer
- cryptorchidism
- family history
- personal history
what is cryptorchidism and what is at higher risk of testicular cancer
condition where one or both testes fail to descend from abdomen into scrotum
teste that didn’t descend at higher risk
history of testicular lump
- lump: when got, size, tenderness, unilateral vs bilateral
- scrotal trauma?
- pain?
- history of fertility issues
- history of cryptorchidism
- sexual history
- associated symptoms
how can testicular cancer be linked to fertility issues
- teste that is affected by cancer has lower sperm production than normal teste
testicular lump examination
- 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
testicular lump differentials (4) other than testicular cancer
- epididymal cysts
- spermatocele
- hyatid of Morgagni
- hydrocele (may be a warning sign)
what is the Preh’s test
for patients with testicular pain
- if elevate testicles & pain improves
-> suggest epididymitis (inflammation of epididymis - duct behind testis)
what is Cremasteric reflex
- 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
testicular lump - investogations
- urgent US scrotum (1-2 days of presentation) - do not biopsy lump
why is biopsing not done with testicular cancer
act of biopsying in testicular cancer has high risk of seeding cancer and spreading it
testicular lump - investigations after US
if US suggestive of testicular cancer
- referral to urologist
- CT chest, abdo, pelvis - looking for spread of disease
- serum tumour markers
what are the relevant serum tumour markers in testicular cancer investigation
- alpha fetoprotein
- hCG
- LDH
management of testicular cancer
- 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)
what is adjuvant therapy
- cancer treatment given after primary treatments (eg/ surgery) to lower chance of cancer recurrence
- can include chemotherapy, radiotherapy, hormone therapy, etc
adjuvant therapy in early and advanced disease
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
testicular cancer - management
- 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)
for management of testicular cancer, describe fertility management
- 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
in testicular cancer, usually spreads where
- lymph nodes, lungs
in testicular cancer what imaging is good for looking at testes
US
in testicular cancer what is good for looking at spread
CT
