Testicular Cancer Flashcards
What are the risk factors for testicular cancer and how do these affect investigations
Maldescent of testes
Testicular atrophy
Family history
Risk of bilateral disease - biopsy bilaterally
What age range is at highest risk of testicular cancer
15-45 year old males
What are the most common histological types of testicular cancer
Germ cell tumour - 95%
Lymphoma - 4%
Leydig/sertoli - 1%
Germ cell rumours may be:
Seminomatous- 40%
Non Seminomatous - 60%
- Teratoma
- combined
- yolk sac
How does testicular cancer spread and which organs and nodes does it spread to?
Lymphatic spread to para aortic nodes
Metastatic to lungs, liver, bone, brain
Investigations in testicular cancer
Testicular ultrasound
This can differentiate between solid and fluid filled lesions, as well as seminomas and teratomas
Tumour markers
BHCG, AFP raised in non seminoma, LDH to assess prognosis
Tumour markers and ultrasound together decide whether orchidectomy is necessary to confirm pathology
CT for staging
Royal marsden staging
1- confined to testicle
2- para aortic nodes below diaphragm
3- para aortic nodes above diaphragm
4- visceral metastases
Why is the approach through the inguinal canal in orchidectomy for testicular cancer
To reduce spread through the scrotal tissue planes
What adjuvant chemotherapy is used with orchidectomy in stage 1 testicular cancer
Seminoma - one dose carboplatin
Non seminoma - 2 cycles BEP
BEP is bleomycin, etoposide, cisplatin
What chemotherapy is used metastatic testicular cancer
3-4 cycles BEP
Second line is reinduction with taxane chemo
High dose chemo with peripheral stem cell support may be considered if poor prognosis
When is surveillance only an option in testicular cancer?
Low risk stage one testicular cancer
When is radiotherapy used in testicular cancer
Adjuvant therapy to para aortic nodes in stage one disease
Debulking radiotherapy in malignant teratoma
Palliative to brain, bone, nodes
