TESTICULAR TUMOURS Flashcards
Mass in SCROTUM
🚦DIFFERENTIAL DIAGNOSIS🚦
🧠⚡SHOVE IT⚡
SHOVE IT:
1. Spermatocele
2. Hydrocele
3. Haematocele
4. Orchitis
5. Varicocele
6. Epidymal cyst
7. Indirect inguinal hernia
8. Torsion/ Tumor
Classification of TESTICULAR TUMOUR
🧠⚡ Non-seminomatous: CETY⚡
⚡⚡ MOST COMMON TESTICULAR TUMOUR
⚡⚡ MOST COMMON TESTICULAR TUMOUR IN CHILDREN
⚡⚡ MOST COMMON TESTICULAR TUMOUR IN ELDERLY
⚡⚡ MOST COMMON TESTICULAR TUMOUR
🎯 SEMINOMATOUS
⚡⚡ MOST COMMON TESTICULAR TUMOUR IN CHILDREN
🎯 YOLK SAC TUMOURS
⚡⚡ MOST COMMON TESTICULAR TUMOUR IN ELDERLY
🎯 LYMPHOMA
⚡⚡ MOST COMMON B/L TESTICULAR TUMOUR
Lymphoma
⚡⚡ MOST COMMON PRESENTATION OF TESTICULAR TUMOUR
Painless TESTICULAR Mass
Others:
✨ Abdominal Lump: Retroperitoneal Lymph node
✨ Cannon Ball Metastasis to Lung
HURRICANE TUMOUR
✨ Very aggressive CHORIOCARCINOMA
✨ 6 months: SURVIVAL TIME
✨ Exceeds its own blood supply
🎯 Testis Shrinks &
🎯 Metastasis to other organs
Sertoli cell tumour presents as
🧠⚡S for S⚡
Leydig cell tumour presents as
🧠⚡L⚡
🎯 Sertoli cell tumour presents as SILENT tumour ➡️ releases INHIBIN
🎯 LEYDIG cell tumour presents as
✨ Gyanecomastia
Estrogen & Androgen secreting
⭐ Maximum Alpha Fetoprotein is secreted by which TESTICULAR TUMOUR
⭐ ⭐ Maximum Beta HCG is secreted by which TESTICULAR TUMOUR
🧠⚡ In anticlockwise
AD
BC ⚡
FNAC (OR) TRANS-SCROTAL Biopsy is NOT DONE is SUSPECTED TESTICULAR TUMOUR?
DUE TO RISK OF UPSTAGING the Stage
CHEVASSU MANEUVER done in
Suspected TESTICULAR TUMOUR
⬇️
HIGH INGUINAL INCISION
WORK UP IN A SUSPECTED TESTICULAR TUMOUR
Usually TNM Staging is done for most tumours, TNMS staging is done for
TESTICULAR TUMOUR
S = Value of Tumour Markers (Post Orchidectomy Values)
1st DRAINING LYMPH NODE for TESTICULAR TUMOUR
Para-aortic Lymph node
🩺 IOC for STAGING of TESTICULAR CANCER
PET-CT
T STAGING of TESTICULAR TUMOUR
T1: Limited to TESTIS & EPIDIDYMIS ± Involvement of TUNICA ALBUGINA
✨ T1a: < 3cm
✨ T1b: > 3cm
T2: Limited to TESTIS & EPIDIDYMIS ± Involvement of TUNICA ALBUGINA ➕ TUNICA VAGINALIS ➕ Vascular/lymphatic Invasion
T3: Spermatic CORD Involvement ± Vascular/lymphatic Invasion
T4: Invades SCROTUM ± Vascular/lymphatic Invasion
N STAGING of TESTICULAR TUMOUR
N0 : No Regional LN Metastasis
N1: ≤ 5 LN size ≤ 2cm
N2: > 5 LN size > 2cm & < 5cm
N3: Size > 5cm
M STAGING of TESTICULAR TUMOUR
M0: No distant Metastasis
M1A: Lung (OR) Non-regional Lymph nodes
M1B: Metastasis elsewhere
T½ of
⭐ Beta HCG
⭐ AFP
⭐ Beta HCG
🎯 1-3 days
⭐ AFP
🎯 5-7 days
AFP is NEVER RAISED in
Pure SEMINOMA
Tumour Markers for SEMINOMA
🧠⚡TONKI ⚡
- Twelve p Isochromosome (12p)
- OCT3/4
- Nanog
- c-KIT
ITGCN Can give rise to all TESTICULAR Tumours EXCEPT
🧠⚡STP ⚡
- Spermatocytic SEMINOMA
- Teratoma
- Pre-pubertal Yolk Sac Tumour
Difference BETWEEN SEMINOMATOUS & NON-SEMINIMATOUS GCT
💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT
⭐ STAGE 1
Chemotherapy: BEP
💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT
⭐ STAGE 2
Induction CHEMOTHERAPY
⬇️ if LN ➕ & TUMOUR markers ➕
⬇️
RETROPERITONEAL LYMPH NODE DISSECTION
💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT
⭐ STAGE 3
Chemotherapy
⬇️ if LN ➕ & TUMOUR markers ➕
2nd LINE CHEMO
⬇️ if LN ➕ & TUMOUR markers ➕
Salvage RPLND
💊💉 MANAGEMENT of STAGE 1 SEMINOMATOUS GCT
⭐ with GOOD PROGNOSTIC FACTORS
⭐ with BAD PROGNOSTIC FACTORS
⭐ with GOOD PROGNOSTIC FACTORS
🎯 SURVILLANCE
⭐ with BAD PROGNOSTIC FACTORS
🎯 Single Cycle of PLATINUM based CHEMOTHERAPY
💊💉 MANAGEMENT of STAGE 2 SEMINOMATOUS GCT
🧠⚡Stage 2 = TESTIS ➕ LN belows diaphragm⚡
⭐ RADIOTHERAPY (30 Gy) to PARA-AORTIC LN
✨ Inverted Y Fashion
⬇️
⬇️ (residual LN ➕)
Chemotherapy
💊💉 MANAGEMENT of STAGE 3 SEMINOMATOUS GCT
🧠⚡Stage 3 = TESTIS ➕ LN above diaphragm (METASTASIS)⚡
Chemotherapy (BEP)
⬇️ followed by
Radiotherapy
BEP Regimen
Bleomycin
Etoposide
cisPlatin
Lymph node dissection is VERY DIFFICULT in SEMINOMA
Why?
Adherent to VESSELS
In RETROPERITONEAL LYMPH NODE DISSECTION, Always NERVE SPARING Technique must be done
Why?
To MAINTAIN ANTEROGRADE EJACULATION
Role of METASTATECTOMY in TESTICULAR TUMOUR
Survival ⬆️ ⬆️ on removal of Mets
