Testicular Cancer

Question 1

Presentation of testicular cancer

Answer 1

• Non tender (or even reduced sensation)
• Arising from testicle
• Hard without fluctuance or transillumination
• Irregular
• Age 15-40 years
• Typically metastasise to:
  
  • Lymphatics
  • Lungs
  • Liver
  • Brain

Question 2

Types of testicular cancer

Answer 2

• Seminoma (50%)
• Teratoma (50%)
• Rarely other types

Question 3

Diagnosis and management of testicular cancer

Answer 3

• Tumour markers
  
  • 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
• Prognosis
  
  • Good prognosis unless metastatic (>90% cure rate)
  • Even metastatic disease is often curable
  • Slightly better prognosis for seminomas
• Treatment
  
  • Orchidectomy (offer testicular prosthesis)
  • Chemotherapy/radiotherapy based on staging
  • Monitoring post treatment with tumour markers and imaging