Testicular cancer Flashcards
Describe testicular cancer?
- 20-40yrs
- Caucasians and northern europeans
Testes anatomy
How are primary testicular tumours categorised?
- Germ cell tumours (GCT) (majority)
- Seminomas
- Non-seminomatous GCTs (NSGCT)
- Non-germ cell tumours (NGCT)
- Leydig cell tumours
- Sertoli cell tumours
Describe Non-germ cell tumours?
- Usually benign
- Leydig or sertoli cell composition
Describe Seminomas?
- Remain localised until late
- Very good prognosis
Describe Non-seminoma germ cell tumours?
- Yolk sac tumours, choriocarcinoma, embryonal carcinoma, teratoma
- Often matastasise early
- Worse prognosis than seminomas
Risk factors for testicular cancer?
- Cryptorchidism (undescended testes)
- Increased risk of GCTs
- Previous testicular cancer
- Positive family history
- Kleinfelter’s syndrome
What are the clinical features of testicular cancer?
- Unilateral painless testicular lump
- Irregular, firm, fixed lump which does not transilluminate
- Evidence of metastasis:
- Weight loss
- Back pain (retroperitoneal)
- Dyspnoea (lung)
Name some differentials for testicular cancer?
- Epidiymal cyst
- Haematoma
- Epididymitis
- Hydrocoele
Describe the investigations which should be performed if someone is suspected of having testicular cancer?
- Tumour markers (diagnostic and prognostic)
- betaHCG
- AFP
- LDH can be a surrogate marker for tumour volume
- Scrotal ultrasound
- CT with contrast (staging)
What is important to remember about testicular tumours and biopsy?
Should not be performed as it could cause seeding of the tumour
Describe the staging of testicular cancer?
- Royal Marsden Classification
- Disease confined to testes
- Infra-diaphragmatic lymph node involvement
- Supra and infra-diaphragmatic lymph node involvement
- Extralymphatic metastatic spread
Describe the management of testicular cancer?
- Surgery, radiotherapy, chemotherapy
- Surgery: inguinal radical orchidectomy
- Assessment of fertility pre-treatment
- Semen analysis and cryopreservation offered accordingly
Describe the management of Non-seminomatous germ cell tumours?
- Stage 1 NSGCT
- Orchidectomy then either:
- Low risk: surveillance
- High risk: adjuvant chemotherapy
- Orchidectomy then either:
- Metastatic NSGCTs
- Intermediate prognosis:
- Cycles of chemotherapy
- Poor prognosis
- One cycle of chemotherapy
- Intermediate prognosis:
What chemotherapy agents might be used when treating testicular cancer?
- Cisplatin
- Etoposide
- Bleomycin
Describe the treatment of Seminomas?
- Stage 1 seminoma
- Orchidectomy alone + surveillance
- High relapse risk considered for adjuvant chemo
- Metastatic seminoma
- Stage IIA: Radiotherapy or chemotherapy
- Higher stage: primary chemotherapy
Complications of testicular cancer treatment?
Radiotherapy and chemotherapy can increase the risk of secondary malignancies
Which lymph nodes do testicular tumours commonly metastasise to?
Para-aortic
- Which of the following best describes stage III testicular cancer?
- Infra-diaphragmatic lymph node involvement
- Supra and infra diaphragmatic lymph node involvement
- Disease confined to testes
- Extralymphatic metastatic spread
Supra and infra-diaphragmatic lymph node involvement
