Testicular + Prostate Cancer

Question 1

2 main types of testicular cancer?

Answer 1

Seminomas: 50%

Non-seminomatous germ-cell tumours (e.g. teratomas, yolk sac tumour, embryonal carcinoma, choriocarcinoma)

Question 2

2 rarer types of testicular cancer?

Answer 2

Gonadal stromal tumours (Sertoli + Leydig cell)

Non-Hodgkin’s lymphoma

Question 3

7 risk factors for testicular cancer

Answer 3

Maldescended testes
Gonadal dysgenesis 
FHx 
PMH testicular cancer 
Ectopic testes: testes in unknown location 
Atrophic tests: reduced in size 
HIV

Question 4

2 symptoms of testicular cancer

Answer 4

Swelling or discomfort of the testes

Backache due to para-aortic lymph node enlargement

Question 5

Sx may be caused by testicular cancer metastases?

Answer 5

Lung mets: SOB, haemoptysis

Skeletal mets: bone pain

Question 6

4 signs of testicular cancer

Answer 6

Painless, hard nodule on 1 side
May be a secondary hydrocoele
Lymphadenopathy (e.g. supraclavicular, para-aortic)
Gynaecomastia (if produces hCG): more likely a teratoma

Question 7

3 tumour markers that may be raised in testicular cancer

Answer 7

a-fetoprotein: elevated: teratomas / Non seminomatous GCT
b-hCG: elevated: seminomas + teratomas
LDH: elevated

Question 8

principle imaging test used in testicular cancer?

Answer 8

Testicular US
Allows visualisation of tumour

Can see associated hydrocoele

Question 9

Why perform CT chest, abdomen and pelvis in testicular cancer?

Answer 9

Staging (+/- MRI)
Identify enlarged retroperitoneal lymph N
Identify lung mets

Question 10

Why is urine pregnancy test sometimes performed in testicular cancer?

Answer 10

+ve if tumour produces b-hCG

Question 11

List 3 testicular changes that warrant consideration of an urgent referral

Answer 11

Non painful enlargement
Shape
Texture.

Question 12

Describe treatment for testicular cancer

Answer 12

Radical inguinal orchidectomy + Chemotherapy of the affected side
Monitor tumor marker levels

Question 13

What staging systems are used for testicular cancer?

Answer 13

Royal Marsden Hospital Staging

Question 14

When is histological analysis of testicular tumours performed?

Answer 14

After testicular mass is removed

biopsies are not performed due to the risk of seeding

Question 15

How does testicular cancer most commonly spread?

Answer 15

SPREAD TO PARA-AORTIC LYMPH NODES

Question 16

Most common testis affected?

Answer 16

55% Right

Question 17

Chemotherapy used post orchidectomy in testicular cancer

Answer 17

I: Carboplatin
II: Bleomycin, Etoposide + Cisplatin = BEP

Question 18

4 RFs for prostate cancer

Answer 18

Age >50
Afro-Caribbean
FH
Dietary factors (high dietary fat)

Question 19

6 Sx of prostate cancer

Answer 19

Frequency 
Hesitancy 
Poor stream 
Terminal dribbling 
Nocturia 
Dysuria

Question 20

Onset of prostate cancer

Answer 20

Often ASYMPTOMATIC

Question 21

2 signs of prostate cancer

Answer 21

Asymmetrical hard nodular prostate on DRE

Loss of midline sulcus

Question 22

4 Sx caused by metastatic spread of prostate cancer?

Answer 22

Bone pain
Cord compression
FLAWS
Paraneoplastic syndromes (e.g. hypercalcaemia)

Question 23

Ix for prostate cancer

Answer 23

Serum PSA elevated

Transrectal Ultrasound + Needle Biopsy (confirm dx)

Question 24

What staging systems are used for prostate cancer?

Answer 24

Gleason

Question 25

Tx for very low risk prostate cancer

Answer 25

LE 10Y: Observation
LE <20Y: Active surveillance
LE >20Y: above / Interventional

Question 26

Interventional tx for prostate cancer

Answer 26

Brachytherapy
External beam radiotherapy
Radical prostatectomy +/- lymph node dissection

Question 27

Adjuvant tx used in unfavourable intermediate risk

Answer 27

Androgen deprivation therapy
LHRH agonist: overstimulates, initial surge, downregulation
LHRH antagonist: suppresses LH - suppresses testosterone

Question 28

What surgical hormone therapy can be performed in prostate cancer?

Answer 28

Orchiectomy

Remove testis where Testosterone + DHT are made