Testicular Cancer

Question 1

What is testicular cancer?

Answer 1

Malignant tumour of the testes

Question 2

Describe the aetiology of testicular cancer

Answer 2

Believed to start developing during fetal development: congenital abnormalities are an important factor  
Environmental factors (e.g. trauma, hormones + atrophy) + genetic predisposition

Question 3

What are the 2 main types of testicular cancer?

Answer 3

Seminomas: 50%

Non-seminomatous germ-cell tumours (e.g. teratomas, yolk sac tumour, embryonal carcinoma, choriocarcinoma)

Question 4

What are 2 rarer types of testicular cancer?

Answer 4

Gonadal stromal tumours (Sertoli + Leydig cell tumours)

Non-Hodgkin’s lymphoma

Question 5

List 7 risk factors for testicular cancer

Answer 5

Maldescended testes
Gonadal dysgenesis  
FHx  
PMH testicular cancer 
Ectopic testes: testes in unknown location  
Atrophic tests: reduced in size 
HIV infection

Question 6

Describe the epidemiology of testicular cancer

Answer 6

UNCOMMON  
1% of male malignancies  
Common age of onset: 
20-34 yrs for teratomas 
>30 for seminomas

Question 7

Give 2 symptoms of testicular cancer

Answer 7

Swelling or discomfort of the testes

Backache due to para-aortic lymph node enlargement

Question 8

What symptoms may be caused by metastases of testicular cancer?

Answer 8

Lung mets: SOB, haemoptysis

Skeletal mets: bone pain

Question 9

List 4 signs of testicular cancer

Answer 9

Painless, hard testicular mass
May be a secondary hydrocoele
Lymphadenopathy (e.g. supraclavicular, para-aortic)
Gynaecomastia (tumour produces hCG): more likely to be a teratoma

Question 10

What bloods should be taken in testicular cancer?

Answer 10

FBC
U+Es
LFTs: elevated in some pts
Tumour Markers

Question 11

List 3 tumour markers that may be raised in testicular cancer

Answer 11

a-fetoprotein: elevated: teratomas / Non seminomatous germ cell tumour
b-hCG: elevated: seminomas + teratomas
LDH: elevated

Question 12

What is the principle imaging test used in testicular cancer?

Answer 12

Testicular US
Allows visualisation of tumour
Can see associated hydrocoele

Question 13

Why perform CT chest, abdomen and pelvis in testicular cancer?

Answer 13

allows staging (may also use MRI)
May see enlarged retroperitoneal lymph N
Identify lung mets

Question 14

Why is urine pregnancy test sometimes performed in testicular cancer?

Answer 14

Will be positive if tumour produces b-hCG

Question 15

List 3 testicular changes that warrant consideration of an urgent referral

Answer 15

Non painful enlargement
change in shape
change in texture.

Question 16

Describe treatment for testicular cancer

Answer 16

Radical inguinal orchidectomy + Chemotherapy of the affected side
Monitor tumor marker levels

Question 17

What staging systems are used for testicular cancer?

Answer 17

Royal Marsden Hospital Staging

Question 18

When is histological analysis of testicular tumours performed?

Answer 18

After testicular mass is removed

biopsies are not performed due to the risk of seeding

Question 19

How does testicular cancer most commonly spread?

Answer 19

SPREAD TO PARA-AORTIC LYMPH NODES