Testicular masses

Question 1

which tumours are common in younger men?

Answer 1

teratomas ; 20-35

yolk sac tumour (<10y but RARE)

Question 2

which are tumours common in middle aged men?

Answer 2

seminomas; 35-45

Question 3

which are tumours common in older men?

Answer 3

lymphomas

Question 4

see pathology histopath urology cards

Answer 4

okay

Question 5

what is the most common cause of epididymitis/orchitis in men?

Answer 5

Age 30s -> sexually transmittted infections

Age 40s+ -> gut commensals eg e.coli

Question 6

Red flag features of scrotal mass;

Answer 6

These are features of a possible cancer;

• Growth; fast growing
• Feel; feels craggy/irregular
• Pain; painless
• Duration; has been present for a while

Question 7

qs to ask in scrotal mass hx?

Answer 7

• Growth;
• Feel;
• Pain;
• Duration;

Sexual hx
FUND HIPS
Testicualr trauma
Lymphadenopathy - other lumps
SOB/abdo pain

PMH: orchidopexy

FH; testicular cancer

SH; smokers

Question 8

what investigations do we do in a man presenting with testicular mass?

Answer 8

Refer to Urology

Urine dip
USS testes
Bloods; Tumour markers and standard FBC + U&Es

Question 9

whihc are the tumour markers in testicular tumours

Answer 9

There are 3:
bHCG
AFP
LDH - better to check response to treatment

Question 10

whihc marker is raised in germ cell tumours?

Answer 10

AFP

Question 11

HCG IS RAISED IN WHICH TUMOURS?

Answer 11

teratoma
choriocarcinoma
seminoma

Question 12

ldh is raised in which tumours?

Answer 12

seminoma

Question 13

An USS scan of a testicular mass comes back suspicious of a tumour. next step?

Answer 13

1. Orchidectomy as soon as possible

(usually take an inguinal approach to this surgery)

2. Followed by;
   Chemotherapy
3. Followed by (if mets):
   +- LND (retroperitoneal - because it drains there)

Question 14

prognosis in testicular cancers?

Answer 14

Seminomatous tumours;
good survival even if mets - >90%

Non- seminatous groups:
still good survival but not as much