Testicular tumours

Question 1

What age patients do testicular tumours affect?

Answer 1

Commonest solid organ malignancy in males 20-35yrs

Question 2

What are the risk factors for testicular tumours?

Answer 2

• testicular maldescent
• Intratubular germ cell neoplasia (ITGCN) is precursor lesion for invasive testicular germ cell tumour of adolescents/young adults

Question 3

what are the different classifications for testicular tumours?

Answer 3

Germ cell tumours:

• 90% seminomas
• teratoma
• mixed

Secondary tumours:

• 10% lymphoma/leukaemia
• stromal cell tumour
• mets.s

Paratesticular tumours:

• adenomatoid tumours
• sarcoma

Question 4

What are the s/s for testicular tumour?

Answer 4

• painless, insensitive, stony hard swelling

- can be assoc. with hydrocele, gynaecomastia, malignant disease effects

Question 5

What proportion of testicular tumour pt.s present due to met.s?

Answer 5

10%

Question 6

What is the diagnosis of testicular tumours?

Answer 6

• US is 95% specificity/sensitivity and done on all suspicious testicles
• CXR and abdo CT done after testicle removed to stage

Question 7

Biochemical markers:
AFP
BHCG
LDH
PLAP
-when are these high?

Answer 7

AFP (yolk sac components) - never raised in pure seminoma (useful serum marker for teratoma)

BHCG (trophoblastic comp.) - 5-10% pure seminoma, 100% teratomas have raised HCG

LDH - indicates tumour burden (load)

PLAP (placental Alk phos) - raised in seminoma

Teratoma: BHCG and AFP

Seminoma: PLAP and maybe BHCG

Question 8

Describe the treatment of testicular cancer?

Answer 8

• orchidectomy, inguinal approach to reduce rate of recurrence rather than scrotal approach
• high ligation of cord
• prosthesis
• if risk of ITGCN do contralateral biopsy e.g. undescended testes

Question 9

Seminoma:

• what % of GCT?
• Age affected
• pathology
• spread
• radiosensitivity?

Answer 9

40% GCT (commonest)

Age: 30-50yrs (rare before puberty)

Pathology: solid, homogenous, pale, potato tumour
-large clear tumour cells with variable stromal lymphocytic infiltrate

Spread:
Lymphatic - para-aortic lymph nodes (often massive)
Blood - lungs/liver

Radiosensitivity: >95% cure rate as v. radiosensitive

Question 10

Teratoma:

• what % of GCT?
• Age affected
• pathology
• radiosensitive?

Answer 10

32% GCT

Age: 20-30yrs, can occur in childhood

Pathology: variable - solid areas/cystic/haemorrhages/necrosis
-100% have raised HCG

Radioresistant but chemo sensitive

Question 11

Mixed teratoma/seminoma

• what % of GCT?
• prognosis of this depends on what?

Answer 11

• 14% GCT

- depends on most malignant tissue present

Question 12

What lymph nodes do testicular tumours metastasise to?

Answer 12

-abdominal lymph nodes

Question 13

Describe the management of testicular tumours?

Answer 13

• specialist centre, sperm storage
• surveillance vs radiotherapy
• residual post-treatment masses: have to do retoperitoneal lymph node dissection