Testicular Cancer Flashcards
What is the most common presentation associated with testicular germ cell tumours?
painless, unilateral testicular or scrotal mass
Why may a patient presenting with testicular cancer have back or flank pain?
metastases
A patient with confirmed testicular cancer presents with gynaecomastia - what does this tell you about the tumour?
it is producing beta-hCG (which is associated with metastasis)
What other condition presents similarly to testicular cancer and how can you differentiate the two conditions?
epididymo-orchitis
differentiate using an abdominal examination - supraclavicular lymphadenopathy and a palpable abdominal mass indicates cancer
How often are men recommended to check their testicles for lumps?
every month
What is the most common cancer in men aged 15-35?
testicular cancer
What are the two main types of testicular germ cell tumours?
1) seminoma
2) non-seminoma e.g. teratomas
What serum tumour marker are seminomas associated with?
alpha fetoprotein and LDH (lactate dehydrogenase)
What 2 investigations can be used to confirm diagnosis of testicular cancer following examination?
1) ultrasound or MRI
2) serum tumour marker bloods - LDH, beta-hCG
How are seminomas treated?
radial inguinal orchidectomy followed by adjuvant chemotherapy or radiotherapy to the para-aortic lymph nodes
What are the two most common sites of testicular cancer metastasis?
1) para-aortic lymph nodes
2) lungs
True or false: majority of men undertaking chemotherapy for testicular cancer lose their fertility
False
are seminoma or non-semiona germ cell testicular tumours more common?
SEMINOMA
what are examples on non-germ cell testicular tumours?
- leydig cell tumours
- sarcoma
what is the epidemiology of testicular cancer?
- seminoma = 35yrs (OLDER)
- teratoma (non-seminoma) = 25yrs (YOUNGER)
what is the aetiology of testicular cancer?
- <45yrs
- caucasian males
- infertility
- cryptorchidism (undescended teste)
- FH
- Klinefelter’s syndrome
what are the clinical features of testicular cancer?
- a painless lump in the scrotum
- gynaecomastia due to increased oestrogen:androgen ratio present with germ cell tumours
what are the investigations for testicular cancer?
- scrotal ultrasound
- serum tumour markers = AFP, hCG and LDH
- CT TAP for staging
- 2 week wait
what are the differential diagnosis for testicular cancer?
- epididymal cyst
- testicular torsion
- epididmitis
- hydrocele
- variocele
- inguinal hernia
What are 4 risk factors for testicular cancer?
- Undescended testes
- Male infertility
- Family history
- Increased height
What is the typical presentation of testicular cancer?
Painless lump on testicle
Clinical features include:
Non-tender (or even reduced sensation)
Arising from testicle
Hard
Irregular
Not fluctuant
No transillumination
Which type of tumour can gynaecomastia be a sign of?
Leydig tumour
What is the staging system of testicular cancer?
Royal Marsden Staging System
What are the 4 stages of the Royal Marsden staging system?
Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs
What are 4 common sites for mets of testicular cancer?
Lymphatics
Lungs
Liver
Brain
What are some side effects of treatment for testicular cancer?
Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Lasting kidney, liver or heart damage
Increased risk of cancer in the future
