Testicular Cancer

Question 1

Define Testicular Cancer?

Answer 1

Malignant tumour of the testes

Question 2

What are the different types of Testicular Cancer?

Answer 2

Seminomas - 50%
Non-seminomatous germ-cell tumours and teratomas - 30%
RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) and non-Hodgkin’s Lymphoma

Question 3

What are the risk factors for Testicular Cancer?

Answer 3

Maldescended Testes
Ectopic Testes
Atrophic Testes

Question 4

What is the epidemiology of Testicular Cancer?

Answer 4

UNCOMMON
1% of Male Malignancies
Common age of onset: 18-35 years

Question 5

What are the presenting symptoms of Testicular Cancer?

Answer 5

Swelling or discomfort of the testes
Backache due to para-aortic lymph node enlargement
Lung metastases leads to SOB and Haemoptysis

Question 6

What are the signs of Testicular Cancer on physical examination?

Answer 6

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

Question 7

What investigations do we do for Testicular Cancer?

Answer 7

Bloods 
Urine Pregnancy Test 
CXR 
Testicular US 
CT Abdomen and Thorax

Question 8

What bloods do we do for Testicular Cancer?

Answer 8

FBC
U&Es
LFTs
Tumour Markers

Question 9

What tumour makers do we see?

Answer 9

a-feroprotein
B-hCG
LDH

Question 10

Why do we do a Urine Pregnancy for Testicular Cancer?

Answer 10

Will be positive if the tumour produces B-hCG

Question 11

Why do we do a CXR for Testicular Cancer?

Answer 11

Shows lung metastases

Question 12

Why do we do Testicular US for Testicular Cancer?

Answer 12

Allows visualisation of the tumour

Can see associated hydrocoele

Question 13

Why do we do CT Abdomen and Thorax in Testicular Cancer?

Answer 13

Allows Staging

Staging System: Royal Marsden Hospital Staging