Testicular cancer

Question 1

Define

Answer 1

DEFINITION: malignant tumour of the testes

Types:

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 2

Causes/ Risk factors

Answer 2

UNKNOWN

Risk Factors

Maldescended testes

Ectopic testes

Atrophic testes

Question 3

Epidemiology

Answer 3

UNCOMMON

1% of male malignancies

Common age of onset: 18-35 yrs

Question 4

Symptoms

Answer 4

Swelling or discomfort of the testes

Backache due to para-aortic lymph node enlargement

Lung metastases –> SOB, haemoptysis

Question 5

Signs

Answer 5

Painless, hard testicular mass

There may be a secondary hydrocoele

Lymphadenopathy (e.g. supraclavicular, para-aortic)

Gynaecomastia (tumour produces hCG)

Question 6

Investigations

Answer 6

Bloods

• FBC
• U&Es
• LFTs
• Tumour Markers
  
  • a-fetoprotein
  • b-hCG
  • LDH

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

CXR - show lung metastases

Testicular Ultrasound

• Allows visualisation of the tumour
• Can see associated hydrocoele

CT Abdomen and Thorax - allows staging

• Staging System: Royal Marsden Hospital Staging