Testicular cancer (URO) Flashcards
Who is testicular cancer common among?
Young adult men (20-34 years old)
What is the most common type of testicular cancer?
Seminomas (germ cell tumour)
What are the types of testicular cancer? (3)
- seminomas (germ cell tumour, most common)
- non-seminoma germ cell tumours (teratomas)
- non-germ cell tumours
When do germ cell tumours begin (testicular cancer)?
Germ cell tumours start from foetal development –> carcinoma in situ (intratubular germ cell neoplasia unclassified) –> malignant growth (growth beyond basement membrane)
What are the risk factors for testicular cancer? (8)
- cryptorchidism
- gonadal dysgenesis
- infertility
- age <45
- Fx / personal Hx
- testicular atrophy
- white ethnicity
- HIV
Who is more likely to develop testicular cancer?
Infertile men 3x more likely to develop testicular cancer
How does testicular cancer typically present?
Hard, painless nodule on one testis noticed by the patient or at regular clinic exam
What are the clinical features of testicular cancer? (7)
- painless unilateral hard nodular testicular mass
- negative transillumination test (light does not shine through)
- gynaecomastia - due to seminoma/non-seminoma secreting hCG (increased oestrogen:androgen ratio)
- may be associated hydrocoele
- lymphadenopathy
- lower extremity swelling
- metastatic disease (cough, SOB, chest pain, bone pain - backache)
What is the transillumination test like in testicular cancer?
Negative transillumination test (light does not shine through) - as opposed to positive in hydrocoele
Why might we see gynaecomastia in testicular cancer?
Due to seminoma/non-seminoma germ cell tumour producing hCG –> increased oestrogen:androgen ratio
What features of metastatic disease might we see in testicular cancer? (4)
- cough
- SOB
- chest pain
- bone pain (back pain)
Which lymph nodes does testicular cancer typically spread to?
Para-aortic lymph nodes
How will a hydrocoele differentiate from a testicular cancer? (3)
- transilluminates
- not separate to testis
- fluctuant
What is the first-line principal investigation for testicular cancer?
Ultrasound with colour Doppler of testis - shows testicular mass
Which tumour markers can you check for in testicular cancer? (3)
- alpha-fetoprotein (AFP)
- beta-hCG
- LDH
What are tumour markers like in seminoma (testicular cancer)?
- normal AFP (vs raised in non-seminoma)
- raised beta-hCG sometimes
- raised LDH sometimes
What are tumour markers like in non-seminoma germ cell tumours (testicular cancer)?
- raised AFP (vs normal in seminoma)
- raised beta-hCG
- normal LDH
How can we stage testicular cancer and look for metastases? (2)
- CXR - check for lung mets
- CTAP - allows staging, enlarged retroperitoneal lymph nodes
What confirms diagnosis of testicular cancer?
Histological examination of testicular mass post-orchiectomy (biopsy not advised before surgery for evaluation)
How can testicular cancer cause paraneoplastic hyperthyroidism?
Alpha subunits of hCG and TSH are similar in shape –> tumour which causes excess hCG also stimulates TSH receptors of thyroid gland
What are some differential diagnoses for testicular cancer? (8)
- testicular torsion (sudden, horizontal, rotated, high-riding testis, US shows hypoechogenicity and enlargement, blood flow occlusion)
- epididymo-orchitis (inflammation, shorter Hx, Doppler shows increased blood flow)
- scrotal hernia
- hydrocoele (transilluminating, testis cannot be palpated)
- epididymal cyst
- haematoma
- spermatocele
- intra-testicular benign cysts
How would you manage a patient with testicular cancer prior to surgery?
Sperm cryopreservation - tumours associated with decreased fertility, and infertility can be a complication of treatment
How can we surgically remove testicular cancer? (2)
Radical inguinal orchiectomy - involved testicle, spermatic cord and appendages removed
Or testis sparing surgery - for those wanting to preserve gonadal function with mass <2mm, those with negative tumour markers and unclear imaging, single functional testis, bilateral tumour
How else is a patient with testicular cancer managed, outside of surgery?
Radiotherapy and chemotherapy
What can we offer to patients with testicular cancer post-orchiectomy? (6)
- surveillance
- carboplatin chemotherapy (where f/u compliance is questionable)
- external beam radiation
- retroperitoneal lymph node dissection
- chemotherapy
- combination chemotherapy (if advanced/metastatic)
What is a complication of testicular cancer?
Infertility - after orchiectomy, retroperitoneal LN dissection, chemotherapy and radiotherapy
Hence sperm banking advised/sperm cryopreservation
What is the prognosis of testicular cancer like?
Excellent - high cure rate and 5y survival rates >95%
