Testicular Cancer

Question 1

Definition

Answer 1

Malignant tumour of the testes

Question 2

Types

Answer 2

o Seminomas - 50%

o Non-seminomatous germ-cell tumours and teratomas - 30%

o RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) and non-Hodgkin’s lymphoma

Question 3

Aetiology

Answer 3

Unknown

Question 4

Risk factors

Answer 4

o Maldescended testes
o Ectopic testes
o Atrophic testes

Question 5

Epidemiology

Answer 5

· UNCOMMON
· 1% of male malignancies
· Common age of onset: 18-35 yrs

Question 6

Presenting symptoms

Answer 6

· Swelling or discomfort of the testes
· Backache due to para-aortic lymph node enlargement
· Lung metastases –> SOB, haemoptysis

Question 7

Signs on physical examination

Answer 7

· Painless, hard testicular mass
· There may be a secondary hydrocoele
· Lymphadenopathy (e.g. supraclavicular, para-aortic)
· Gynaecomastia (tumour produces hCG)

Question 8

Investigations (bloods)

Answer 8

o FBC

o U&Es

o LFTs

o Tumour Markers
· a-fetoprotein
· b-hCG
· LDH

Question 9

Investigations (other)

Answer 9

· Urine Pregnancy Test - will be positive if the tumour produces b-hCG

· CXR - show lung metastases

· Testicular Ultrasound
o Allows visualisation of the tumour
o Can see associated hydrocoele

· CT Abdomen and Thorax - allows staging
o Staging System: Royal Marsden Hospital Staging