Testicular cancer (module 5 cont.) Flashcards
epidemiology of testicular cancer
most common cancer for aged 15-34 men
major risk factors of testicular cancer
cryptorchidism (increases risk x6)
previous Hx of testicular cancer)
atrophy eg. mumps, orchitis, trauma
genetic syndromes especially Klinefelter’s disease
is secondary testicular cancer common?
no, it is rare
most testicular cancers are primary
types of testicualr cancer (classification)
Germ cell tumours (GCT)
1. seminoma (half of cases)
2. non seminomatous germ cell tumours (NSGCT)
Non Germ Cell Tumours (Non-GCTs)
1. lymphoma (common in >50yo)
2. leydig cell tumours
3. Sertoli cell tumours
4. other
which cells produce testosterone
leydig cells
which cells nourish the sperm
Sertoli cells
which type of testicualr cancer represents half of all cases
GCT Seminoma
what are the Non-GCT testicular tumours
- lymphoma (common in >50yo)
- leydig cell tumours (cells that make testosterone)
- Sertoli cell tumours (cells that nourish the sperm)
- other
What are the Non Seminomatous Germ Cell Tumours (NSGCTs)
- yolk sac
- embryonal
- teratoma
- choriocarcinoma
clinical features of testicular cancer presentation
usually presents as a painless lump
patient will frequently recall a non-significant testicular trauma or event (this is a red herring)
occasionally may present with acute testicular pain, hydrocoele, or metastatic disease
associated signs and symptoms of testicular cancer
weight loss
seizures
cough/haemoptysis
abdominal distension/pain
swelling of ankles
occasionally may have features of hormone production (eg. choriocarcinoma, leydig)
what are features of hormone production?
gynaecomastia
altered libido etc.
when will tumour markers be raised
50% of tumours
90% of advanced tumours
when should tumour markers be monitored
before, during and after treatment
alpha feto protein (a-FP)
half life of 5-7 days
produced by foetal gut, liver and yolk sac
elevated in liver, pancreatic, stomach and lung tumours also
also raised in normal pregnancy and benign liver disease
b-HCG
half life of 24-36 hours
it implies syncytiotrophoblastic component (choriocarcinoma)
produced by placental tissue
is produced by many subtypes especially choriocarcinoma
elevated in upper GI, lung and bladder tumours also
LDH
non specific tumour markers
measures burden of metastatic disease
CT chest/abdomen/pelvis
used to stage the disease/check for mets and nodes
LDH used for testicular cancer is best used for measuring
burden of metastatic disease
b-HCG is especially raised by
choriocarcinoma
staging of testicular cancer
uses Tumour Node Metastasis (TNM)
testicualr cancer is the only malignancy that also uses S stage (Serum markers) by measuring both the presence and level of serum markers
what are the serum markers for testicualr cancer
a-FP
b-HCG
LDH
treatment for testicular cancer
removal of the affected testicle is urgent
why is it so urgent to remove the cancer affected testicle
Cancer of the testis has one of the fastest doubling times of all malignancies
patient should be referred to a urologist without delay
process of removing the testicle
urologist removes testicle and cord through inguinal canal, rather than the scrotum
enables early control of venous drainage prior to manipulating
avoids seeding the scrotal tissues with cancer cells
removes initial lymphatic drainage pathway of testicle(via cord)
orchidectomy
removal of testicle
most patients have _ after orchidectomy
chemotherapy or radiotherapy
seminoma are very radiosensitive and chemosensitive
non-seminomas are very chemosensitive
prior to treatment patents should be offered
sperm banking
patient may be offered a prosthesis (artificial testicle) by their urologist
prior to treatment what else should be done
serum markers should be sent
patients disease should be staged (CT abdominal/pelvis/chest)
after orchidectomy
patients require prologued follow up (10y+)
recurrence can occur many years down the track
prognosis of testicular cancer
follows from tumour subtype and staging
advances in chemo have improved survival
high cure rates
what type of testicular cancer has the poorest prognosis
non-seminoma with high markers and visceral metastasis fare poorest
long term effects of testicular cancer treatment
bleomycin chemotherapy may cause long fibrosis
etoposide chemotherapy may cause hair loss
radiotherapy is associated with secondary malignancy risk
orchidectomy may have psychological impact
main risk factor of testicular cancer
undescended testes
