Testicular cancer

Question 1

Examination findings for testicular cancer

Answer 1

◦Non tender (or even reduced sensation)
◦Arising from testicle
◦Hard without fluctuance or transillumination
◦Irregular
◦Age 15-40

Question 2

DDx hydrocele

Answer 2

◦Tunica vaginalis is a membrane around each testicle
◦Hydrocele is fluid built up inside this membrane
◦Transilluminated by shining torch into the fluid
◦It is soft, fluctuant and may be large
◦It is irreducible and has no bowel sounds
◦May indicated underlying testicular cancer
◦May require surgical intervention

Question 3

DDx Varicocele

Answer 3

◦Soft “bag of worms”
◦Swollen pampiniform venous plexus (testicular veins)
◦Can cause dragging or soreness
◦Usually harmless

Question 4

DDx Epidydmil cyst

Answer 4

◦A cyst (sac of fluid)
◦At the epididymis (at the top of the testicle)
◦Soft, fluctuant lump at the top of the testicle
◦Usually harmless

Question 5

DDx Inguinal Hernia

Answer 5

◦Separate from testicle
◦Soft
◦Bowel sounds
◦Reducible

Question 6

What types of cancer are testicular cancers usually

Answer 6

•Seminoma (50%)
•Teratoma (50%)
(germ cell)

Question 7

What are some tumour markers for testicular cancer?

Answer 7

• Alpha-fetoprotein may be raised in teratomas (not seminomas)
• Beta-hCG may be raised in teratomas and seminomas, but more often in teratomas
• Lactate dehydrogenase

Question 8

Location of mets?

Answer 8

• Lymphatics
• Lungs
• Liver
• Brain

Question 9

Prognosis

Answer 9

• Good prognosis unless metastatic (>90% cure rate)
• Even metastatic disease is often curable
• Slightly better prognosis for seminomas

Question 10

Treatment

Answer 10

• Orchidectomy (offer testicular prosthesis)
• Chemotherapy / radiotherapy based on staging
• Monitoring post treatment with tumour markers and imaging