Testicular cancer

Question 1

What are types of testicular cancer?

Answer 1

Germ cell (seminoma - good prognosis - and non-seminoma - bad prognosis)

Non-germ cell (usually benign

Question 2

What are risk factors for testicular cancer?

Answer 2

• 25-40
  
  • Cryptorchidism
  • HIV
  • Caucasian
  • Family history
  • Klinefelter’s
  • History of previous testicular cancer
  • Chemical carcinogens are weak risk factors

Question 3

What are Sx of testicular cancer?

Answer 3

Painless testicular lump
Irregular, firm, fixed, and does not transilluminate

Check for other lymph nodes

Mets: weight loss, back pain

Question 4

What DDx in testicular cancer?

Answer 4

• Epididymal cyst
• Haematoma
• Epididymitis
Hydrocoele

Question 5

What Ix in testicular cancer?

Answer 5

Scrotal US with colour Doppler: non-homogenous mass with increased vascularity

Tumour markers
• Raised BHCG (seminoma/NSGCT)
• Raised AFP (NSGCT)

Raised LDH

CT CAP for mets

Question 6

Why shouldn’t biopsy be done in suspected testicular cancer?

Answer 6

Can cause cancer seeding.

Question 7

What is Rx of testicular cancer?

Answer 7

Radical orchidectomy: removes the testes along with the spermatic cord, allowing for maximal lymphatic system to be removed. Inguinal approach

Testis sparing: if certain criteria met e.g. small mass, no tumour markers

Seminoma: stage 1, orchidectomy alone with prophylactic chemo/radio. Stage >2 = +radio +/-chemo

NSGCT: stage 1 = orchidectomy, stage >2 = + chemo.

Question 8

What should be done in patients undergoing orchidectomy

Answer 8

Pre-treatment fertility assessment: semen analysis and cryopreservation.

Question 9

What are stages of testicular cancer?

Answer 9

1 = confined to testes
2 = infra-diaphragmatic lymph node involvement
3 = + supra
4 = extralymphatic mets

Question 10

What are complications of testicular cancer?

Answer 10

Radio + chemo - secondary malignancies

Infertility