Testicular cancer

Question 1

Describe testicular cancer?

Answer 1

• 20-40yrs
• Caucasians and northern europeans

Question 2

Testes anatomy

Answer 2

Question 3

How are primary testicular tumours categorised?

Answer 3

• Germ cell tumours (GCT) (majority)
  
  • Seminomas
  • Non-seminomatous GCTs (NSGCT)
• Non-germ cell tumours (NGCT)
  
  • Leydig cell tumours
  • Sertoli cell tumours

Question 4

Describe Non-germ cell tumours?

Answer 4

• Usually benign
• Leydig or sertoli cell composition

Question 5

Describe Seminomas?

Answer 5

• Remain localised until late
• Very good prognosis

Question 6

Describe Non-seminoma germ cell tumours?

Answer 6

• Yolk sac tumours, choriocarcinoma, embryonal carcinoma, teratoma
• Often matastasise early
• Worse prognosis than seminomas

Question 7

Risk factors for testicular cancer?

Answer 7

• Cryptorchidism (undescended testes)
  
  • Increased risk of GCTs
• Previous testicular cancer
• Positive family history
• Kleinfelter’s syndrome

Question 8

What are the clinical features of testicular cancer?

Answer 8

• Unilateral painless testicular lump
  
  • Irregular, firm, fixed lump which does not transilluminate
• Evidence of metastasis:
  
  • Weight loss
  • Back pain (retroperitoneal)
  • Dyspnoea (lung)

Question 9

Name some differentials for testicular cancer?

Answer 9

• Epidiymal cyst
• Haematoma
• Epididymitis
• Hydrocoele

Question 10

Describe the investigations which should be performed if someone is suspected of having testicular cancer?

Answer 10

• Tumour markers (diagnostic and prognostic)
  
  • betaHCG
  • AFP
• LDH can be a surrogate marker for tumour volume
• Scrotal ultrasound
• CT with contrast (staging)

Question 11

What is important to remember about testicular tumours and biopsy?

Answer 11

Should not be performed as it could cause seeding of the tumour

Question 12

Describe the staging of testicular cancer?

Answer 12

• Royal Marsden Classification
  
  1. Disease confined to testes
  2. Infra-diaphragmatic lymph node involvement
  3. Supra and infra-diaphragmatic lymph node involvement
  4. Extralymphatic metastatic spread

Question 13

Describe the management of testicular cancer?

Answer 13

• Surgery, radiotherapy, chemotherapy
• Surgery: inguinal radical orchidectomy
• Assessment of fertility pre-treatment
  
  • Semen analysis and cryopreservation offered accordingly

Question 14

Describe the management of Non-seminomatous germ cell tumours?

Answer 14

• Stage 1 NSGCT
  
  • Orchidectomy then either:
    
    • Low risk: surveillance
    • High risk: adjuvant chemotherapy
• Metastatic NSGCTs
  
  • Intermediate prognosis:
    
    • Cycles of chemotherapy
  • Poor prognosis
    
    • One cycle of chemotherapy

Question 15

What chemotherapy agents might be used when treating testicular cancer?

Answer 15

• Cisplatin
• Etoposide
• Bleomycin

Question 16

Describe the treatment of Seminomas?

Answer 16

• Stage 1 seminoma
  
  • Orchidectomy alone + surveillance
  • High relapse risk considered for adjuvant chemo
• Metastatic seminoma
  
  • Stage IIA: Radiotherapy or chemotherapy
  • Higher stage: primary chemotherapy

Question 17

Complications of testicular cancer treatment?

Answer 17

Radiotherapy and chemotherapy can increase the risk of secondary malignancies

Question 18

Which lymph nodes do testicular tumours commonly metastasise to?

Answer 18

Para-aortic

Question 19

• 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

Answer 19

Supra and infra-diaphragmatic lymph node involvement