Testicular cancers Flashcards
clinical features of testicular cancers
nodule, painless swelling of one testicle
dull ache or heavy discomfort in lower abdomen
scrotum and perianal area
gynecomastia
metastatic symptoms of testicular cancer:
neck mass (lymph node)
cough dyspnea (pulmonary)
bone pain (skeletal)
CNS symptoms
unilateral or bilateral lower extremity swelling (iliac thrombosis)
diagnostic evaluation of testicular cancer
scrotal ultrasound - differentiate between cystic and hypoechoic lesions
need staging via CT abd/pelvis to evaluate for retroperitoneal lymph nodes
needs a CXR to evaluate for spread to lungs.
serum tumor markers: alpha fetoprotein beta Hcg and LDH
TO diagnose testicular masses you need to do
radical inguinal orchiectomy for histological diagnosis
no biopsy due to seeding
majority of testicular cancers are either
germ cells (GCT) which can be differentiated further into seminomas and non seminomatous tumors
classic presentation of testicular cancer
painless scrotal swelling.
non seminomas will have these tumor markers
elevated AFB and may have or beta HcG
pure seminomas will have these tumor markers
elevated beta Hcg but AFB is NOT elevated.
acute testicular pain and tenderness on exam is indicative of
epididymitis
seminoma vs non seminoma
non seminomas will have elevated alpha fetoprotein levels
seminomas - normal alpha fetoprotein levels
non seminomas are
embroynal carcinoma teratomas choriocarcinoma yolk sac tumors
approach to patient who has a solid testicular growth…
it’s cancer until proven otherwise.
need beta HcG, alpha fetoprotein levels and testicular ultrasound ordered
seminoma labs:
normal to elevated beta Hcg normal alpha fetoprotein levels
non seminomas labs:
elevated beta Hcg elevated alpha fetoprotein levels
treatment of testicular cancers:
for seminomas or non seminomas do radical orchiectomy via high inguinal excision then according to staging treat
stage 1 testicular cancer is
defined as being confined to testes
seminomas - Radiation therapy or carboplatin
nonseminomas - observe or remove lymph nodes
