Testicular cancer

Question 1

What types of testicular cancers are there?

Answer 1

Seminoma 5%

NSGCT 95%

Question 2

RF for Testicular cancer(5)?

Answer 2

Cryptorchism (testes not in scrotum)
Infertility 
FHx
Kleinfelters
Mumps Orchitis

Question 3

How does testicular cancer present?

Answer 3

Painless lump

Can cause pain, hydrocele, gynaecomastia or mediastinal mass

Question 4

How are scrotal masses investigated?

Answer 4

Ultrasound
Tumour markers
Radical inguinal orchidectomy +/- retroperitoneal LN dissection

Question 5

What tumour markers do you get with Seminoma?

Answer 5

Elevated beta hCG in 10-25%

Question 6

What tumour markers do you get with NSGCT?

Answer 6

Elevated beta hCG in 40%
Elevated AFP in up to 60%
LDH elevated in up to 60%

Used for staging

Question 7

Management of Stage 1 or 2 Seminoma?

Answer 7

Stage 1 - disease in testicle
- Resection + active surveillance 
(or para-aortic LN radiation or single agent carboplatin if this can't be done)
Stage 2  - local LN only
- Radiation and platinum chemo

Question 8

Management of early stage NSGCT?

Answer 8

Early stage

• if no RF resect then active surveillance,
• If RF, then Resect + RPLND + BEP (bleomycin, carboPlatin, etoposide)
• Then if relapse use salvage chemotherapy

Question 9

Management of Advanced Testicular cancer?

Answer 9

BEP (bleomycin, etoposide, carboPlatinum)

if patients are refractory, can hive high dose chemotherapy with auto SCT