testicular cancer Flashcards
What type of cancer is testicular cancer? (2)
Germ cell (90%+) or non germ-cell (<10%) tumour
Germ = seminoma (mc) or teratoma
Non germ = sertoli, leydig, sarcoma
Presentation of testicular cancer (5)
- Painless, hard, irregular lump in testicle
- Does not transilluminate
- May show lung metastasis signs, eg: cough -> consider chest x-ray
- back pain/teste pain
- Gynaecomastia (breast enlargement) if it is a Leydig cell tumour (rare)
Risk factors for testicular cancer (6)
- Most common cancer in young men 20-45 (more common in caucasians)
- Cryptorchidism (undescended testes)
- HIV
- Previous testicular cancer
- Infertility
- height
- Family history
Diagnosis of testicular cancer (5)
- Examination including lymph nodes, testes and scars from previous orchidoplexy
- Urgent (Doppler) ultrasound of testes (90% diagnostic)
- Bloods for tumour markers
- CXR if resp symptoms
- Staging: CT chest/abdo/pelvis
Royal Marsden staging system for testicular cancer (4)
NOW OUTDATED SO JUST KIND OF RECOGNISE IT - used for treatment
1. Isolated to testicle
2. Spread to retroperitoneal lymph nodes
3. Spread to lymph nodes above diaphragm
4. Metastasised to other organs (mc: lymphatics, lungs, liver, brain)
Tumour markers for testicular cancer (3)
- beta hCG - raised in seminomas
- AFP - raised in teratomas
- LDH raised non-specifically
Treatment of testicular cancer (3)
- Urgent inguinal orchidectomy (+ offer sperm banking)
- Adjuvant chemotherapy BEPX3 / EPX4
Or radiotherapy
AJCC TNM staging system - most recent up to date
B-hcg
raised in seminotomas
~15–20% of seminomas produce β-hCG due to the presence of syncytiotrophoblastic giant cells within the tumor.
- only slightly raised
- massively raised in choriocarcinoma
AFP NEVER raised in seminotomas
AFP
- Raised in teratomas with yolk sac involvement
LDH raised non-specifically
Yes, LDH (Lactate Dehydrogenase) can be raised in testicular cancer, but it’s considered a non-specific marker because it can be elevated in a variety of conditions, not just cancer.
Urgent inguinal orchidectomy (+ offer sperm banking)
- Remove the testical by making an insertion into the inguinal region
- affects fertility so offer sperm banking
countries of highest incidence and mortality
incidence:
- eurpoe + australia
mortality:
- south america
- eastern europe
genetic factors
