Testicular cancer

Question 1

Define and types

Answer 1

• Malignant tumour of the testes
• Types:
o Seminomas - 50%
o Non-seminomatous germ-cell tumours and teratomas - 30%
o RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) and non-Hodgkin’s lymphoma

Question 2

What are the risk factors?

Answer 2

o	Maldescended testes (cryptorchidism)
o	Ectopic testes 
o	Atrophic tests 
o	Family history
o	White ethnicity 
o	HIV

Question 3

What’s the aetiology?

Answer 3

Unknown

All germ cell tumours have a non-invasive stage – carcinoma in situ. The malignant transformation of carcinoma in situ is characterised by growth beyond the basement membrane, eventually replacing most of the testicular parenchyma.

Environmental factors (trauma, hormones, and atrophy) and genetic predisposition (gain of the chromosomal arm 12p) are also thought to play a role in the development of the disease. A combination of these factors is thought to be the leading cause of this condition.

Question 4

Epidemiology

Answer 4

• UNCOMMON
• 1% of male malignancies
• Most common malignancy in young adult men
• Common age of onset: 18-35 yrs

Question 5

What are the presenting symptoms?

Answer 5

• Swelling or discomfort of the testes
• Backache due to para-aortic lymph node enlargement or spinal nerve compression
• Lung metastases –> SOB, haemoptysis

Question 6

What are the signs?

Answer 6

• Painless, hard testicular mass
• There may be a secondary hydrocoele
• Lymphadenopathy (e.g. supraclavicular, para-aortic)
• Gynaecomastia (tumour produces hCG)

Question 7

What are the appropriate investigations?

Answer 7

•	Bloods
o	FBC
o	U&Es
o	LFTs 
o	Tumour Markers
•	alpha-fetoprotein
•	beta-hCG
•	Lactate dehydrogenase (LDH)

• Urine Pregnancy Test - will be positive if the tumour produces beta-hCG

• Testicular Ultrasound
o Allows visualisation of the tumour
o Can see associated hydrocoele

• CT Abdomen and Thorax - allows staging
o Staging System: Royal Marsden Hospital Staging

• CXR - show lung metastases