Testicular cancer (module 5 cont.)

Question 1

epidemiology of testicular cancer

Answer 1

most common cancer for aged 15-34 men

Question 2

major risk factors of testicular cancer

Answer 2

cryptorchidism (increases risk x6)
previous Hx of testicular cancer)
atrophy eg. mumps, orchitis, trauma
genetic syndromes especially Klinefelter’s disease

Question 3

is secondary testicular cancer common?

Answer 3

no, it is rare
most testicular cancers are primary

Question 4

types of testicualr cancer (classification)

Answer 4

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

Question 5

which cells produce testosterone

Answer 5

leydig cells

Question 6

which cells nourish the sperm

Answer 6

Sertoli cells

Question 7

which type of testicualr cancer represents half of all cases

Answer 7

GCT Seminoma

Question 8

what are the Non-GCT testicular tumours

Answer 8

1. lymphoma (common in >50yo)
2. leydig cell tumours (cells that make testosterone)
3. Sertoli cell tumours (cells that nourish the sperm)
4. other

Question 9

What are the Non Seminomatous Germ Cell Tumours (NSGCTs)

Answer 9

• yolk sac
• embryonal
• teratoma
• choriocarcinoma

Question 10

clinical features of testicular cancer presentation

Answer 10

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

Question 11

associated signs and symptoms of testicular cancer

Answer 11

weight loss
seizures
cough/haemoptysis
abdominal distension/pain
swelling of ankles
occasionally may have features of hormone production (eg. choriocarcinoma, leydig)

Question 12

what are features of hormone production?

Answer 12

gynaecomastia
altered libido etc.

Question 13

when will tumour markers be raised

Answer 13

50% of tumours
90% of advanced tumours

Question 14

when should tumour markers be monitored

Answer 14

before, during and after treatment

Question 15

alpha feto protein (a-FP)

Answer 15

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

Question 16

b-HCG

Answer 16

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

Question 17

LDH

Answer 17

non specific tumour markers
measures burden of metastatic disease

Question 18

CT chest/abdomen/pelvis

Answer 18

used to stage the disease/check for mets and nodes

Question 19

LDH used for testicular cancer is best used for measuring

Answer 19

burden of metastatic disease

Question 20

b-HCG is especially raised by

Answer 20

choriocarcinoma

Question 21

staging of testicular cancer

Answer 21

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

Question 22

what are the serum markers for testicualr cancer

Answer 22

a-FP
b-HCG
LDH

Question 23

treatment for testicular cancer

Answer 23

removal of the affected testicle is urgent

Question 24

why is it so urgent to remove the cancer affected testicle

Answer 24

Cancer of the testis has one of the fastest doubling times of all malignancies
patient should be referred to a urologist without delay

Question 25

process of removing the testicle

Answer 25

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)

Question 26

orchidectomy

Answer 26

removal of testicle

Question 27

most patients have _ after orchidectomy

Answer 27

chemotherapy or radiotherapy
seminoma are very radiosensitive and chemosensitive
non-seminomas are very chemosensitive

Question 28

prior to treatment patents should be offered

Answer 28

sperm banking
patient may be offered a prosthesis (artificial testicle) by their urologist

Question 29

prior to treatment what else should be done

Answer 29

serum markers should be sent
patients disease should be staged (CT abdominal/pelvis/chest)

Question 30

after orchidectomy

Answer 30

patients require prologued follow up (10y+)
recurrence can occur many years down the track

Question 31

prognosis of testicular cancer

Answer 31

follows from tumour subtype and staging
advances in chemo have improved survival
high cure rates

Question 32

what type of testicular cancer has the poorest prognosis

Answer 32

non-seminoma with high markers and visceral metastasis fare poorest

Question 33

long term effects of testicular cancer treatment

Answer 33

bleomycin chemotherapy may cause long fibrosis
etoposide chemotherapy may cause hair loss
radiotherapy is associated with secondary malignancy risk
orchidectomy may have psychological impact

Question 34

main risk factor of testicular cancer

Answer 34

undescended testes