Testicular Cancer Flashcards
What are types of testicular cancer?
Germ cell tumours:
Seminomas 35 y peak
Non-seimnomas (embryonal, yolk sac, teratoma, choriocarcinoma) - 25 y peak (younger, fast growing, tumour markers)
Non-germ cell tumours:
Leydig cell tumours
Sarcomas
What are risk factors for testicular cancer?
Infertility Cryptorchidism (fail to descend from abdomen into scrotum) Family history Klinefelter's sydnrome Mumps orchitis
What are CF of testicular cancer?
Painless lump
Pain may be present in minority
Hydrocele
Gynaecomastia
What tumour markers?
AFP in germ cell tumours - not raised in seminomas
LDH in germ cell tumours
hCG in 20% of seminomas
How is testicular cancer diagnosed?
USS scrotum
CT CAP for staging
Excision biopsy
Mx of testicualr cancer
Orchidectomy via inguinal approach
Chemotherapy and radiotherapy
Sperm banking
Abdominal lesions > 1cm following chemotherapy may require retroperitoneal lumph node disseaction
What is epididymo-orchitis?
Inflammation of the epididymis and testis usually caused by bacterial infection
Swelling tender and eased by elevating testis
Spreads from the urethra or bladder
Chlamydia or gonorrhoea
Amiodarone can cause
DDx of scrotal lump
Inguinal hernia Testicular tumours Acute epididymo-orchitis Epididymal cysts Hydrocele Testicular torsion Varicocele
What are epididymal cysts? Mx?
Single or multiple cysts
May contain clear or opalescent fluid (spermatoceles)
Usually occur over 40 years of age
Painless
Lie above and behind testis
It is usually possible to ‘get above the lump’ on examination
Epididymal cysts can be excised using a scrotal approach
What is hydrocele? Mx?
Non painful, soft fluctuant swelling
Often possible to ‘get above it’ on examination
Usually contain clear fluid
Will often transilluminate
May be presenting feature of testicular cancer in young men
Hydroceles are managed differently in children where the underlying pathology is a patent processus vaginalis and therefore an inguinal approach is used in children so that the processus can be ligated. In adults a scrotal approach is preferred and the hydrocele sac excised or plicated.
What is torsion? CF? Mx?
Severe, sudden onset testicular pain
Risk factors include abnormal testicular lie
Typically affects adolescents and young males
On examination testis is tender and pain not eased by elevation
Urgent surgery is indicated, the contra lateral testis should also be fixed
The treatment is prompt surgical exploration and testicular fixation. This can be achieved using sutures or by placement of the testis in a Dartos pouch.
What is varicocele? Mx?
Varicosities of the pampiniform plexus
Typically occur on left (because testicular vein drains into renal vein)
May be presenting feature of renal cell carcinoma
Affected testis may be smaller and bilateral varicoceles may affect fertility
Varicoceles are usually managed conservatively. If there are concerns about testicular function of infertility then surgery or radiological management can be considered.
