Testicular Cancer

Question 1

Main types of testicular cancer (2)

Answer 1

Germ cell (95%)
sex cord (leydig/sertol>oestrogen+testosterone)

Question 2

subtypes of germ cell tumours (5)

Answer 2

seminomas (60%)

non-seminomas (40%)-immature teratoma, choriocarcinoma, lymphoma, yolk sac tumour

Question 3

RFs for testicular ca. (6)

Answer 3

FHx/PMHx
subfertility
cryptorchidism (undescended)
mumps orchitis
Klinefelter's-XXY
testicular atrophy

Question 4

Presentation of testicular ca. (7)

Answer 4

90% have painless lump
dragging sensation
gynaecomastia if HCG elevated
loss of sensation
inflammation
Hx of trauma
can have pain

Question 5

Examination for testicular ca. (2)

Answer 5

suspicious lumps are firm and non-fluctuating

examine cervical, supra-clavicular, axillary and inguinal LNs

Question 6

Ix for testicular ca. (4)

Answer 6

need serum biomarkers(HCG/AFP/LDH) and USS(100% sens) for Dx
CT chest/abdo/pelvis for staging
bone scan if raised ALP
(measure biomarkers before and after RPLND and orchidectomy)

Question 7

Biomarker levels for seminomas (3)

Answer 7

LDH raised
HCG usually normal
AFP never raised

Question 8

Biomarker levels for non-sem germ cell tumours (2)

Answer 8

AFP raised

HCG raised

Question 9

Staging of testicular ca. (4)

Answer 9

1=no evidence of mets
2=infra-diaphragmatic LN involvement
3=supra-diaphragmatic LN involvement
4=extra-lymphatic mets

Question 10

Post-orchidectomy management for stage 1 seminomas (3)

Answer 10

surveillance
radiotherapy
single cycle carboplatin

Question 11

Post orchidectomy Mx for stage 1 non-seminomas (3)

Answer 11

surveillance
RPLND
two cycles of BEP (bleomycin, etopiside, cisplatin)

Question 12

Post orchidectomy Mx for advanced GCT w. good prognosis

Answer 12

three cycles of BEP

Question 13

Mx for advanced GCT w. moderate to poor prognosis

Answer 13

four cycles BEP