Testicular Tumours Flashcards
What is the importance of testicular tumours?
Most common male malignant from 15-44 years
What is the ratio of white:black in testicular tumour?
5:1
How do testicular tumours present?
Painless testicular lump
Haematospermia
Symptoms of mets or lymph node involvement
Hormonal symptoms
What presentation may occur secondary to a testicular tumour?
Hydrocele
What symptoms of mets might be present with testicular tumours?
SOB from lung mets
What symptoms of lymph node involvement may be present with testicular tumours?
Abdominal mass from para-aortic lymphadenopathy
What hormonal symptoms may be present in testicular tumours?
Gynaecomastia
Virilisation
What % of patients with testicular tumours have a contralateral tumour?
5%
What are the risk factors for testicular tumours?
Undescended testis
Infant hernia
Infertility
What % of testicular tumours occur in those with undescended testis?
10%
What are the types of testicular tumours?
Germ cell tumours
Non-seminomas
Sex-cord stromal
Lymphoma/leukaemia
What % of testicular tumours are germ cell tumours?
95%
What are the types of germ cell testicular tumours?
Pure seminomas
Non-seminomas
What % of germ cell testicular tumours are pure seminomas?
40%
What age do pure seminoma germ cell testicular tumours present?
30-40
What tumour markers may be raised in pure seminoma germ cell testicular tumours?
Incrased ßhCG in 15%
Increased placental ALP in some
What is true of pure seminoma germ cell testicular tumours, regarding treatment?
They are very radiosensitive
What are the types of non-seminoma germ cell testicular tumours?
Mixed
Teratoma
Yolk sac
Choriocarcinoma
Where do testicular teratomas arise from?
All 3 germ cell layers
How are testicular teratomas different depending on when they present?
They are common and benign in children, but rare and malignant in adults
What tumour markers do testicular teratomas secrete?
ßhCG and/or AFP
What is true of testicular teratomas, regarding treatment?
Chemosensitive
What is the most common testicular tumour in children?
Yolk sac tumour
What tumour marker is greatly increased in testicular choriocarcinoma?
ßhCG
What are the types of sex-cord stromal testicular tumours?
Leydig cells
Sertoli cells
What is true of the prognosis of Leydig cell tumours?
They are mostly benign
What might Leydig cell tumours secrete?
Androgens or oestrogens
What is true of the prognosis of Sertoli cell tumours?
They are mostly benign
What may Sertoli cell tumours secrete?
Oestrogens
What is the most common malignant testicular mass >60 years?
Non-hodgkins lymphoma
What is the most common malignant testicular mass <5 years?
Acute lymphoblastic leukaemia
What investigations are done in testicular tumours?
Tumour markers
Scrotum US
Staging
What are tumour markers useful for in testicular tumours?
Monitoring
What tumour markers may be raised in teratomas?
AFP and ßhCG
What % of teratomas have raised AFP and ßhCG?
90%
What % of seminomas have raised hCG?
15%
What investigations are used for staging in testicular tumours?
CXR
CT
Why should percutaneous biopsy not be performed in testicular tumours?
May get seeding along needle tract
What can be done if both testes are abnormal, in order to allow patient to have kids?
Semen can be cryopreserved
How are stage 1-2 seminomas managed?
Inguinal orchidectomy and radiotherapy
How is seeding prevented during inguinal orchidectomy for seminoma?
Groin incision allows cord clamping to prevent seeding
How are stage 3-4 seminomas managed?
Inguinal orchidectomy, radiotherapy, and chemotherapy
What chemotherapy regime is used in stage 3-4 seminoma?
Bleomycin
Etoposide
Cisplain
How are stage 1 non-seminomas/teratomas managed?
Inguinal orchidectomy and surveillance
How are stage 2 non-seminomas/teratomas managed?
Orchidectomy + chemo + para-aortic lymph node dissection
How are stage 3 non-seminomas/teratomas managed?
Orchidectomy and chemo
What is involved in surveillance to detect relapse in testicular tumours?
Repeat CT scanning and tumour markers, typically within 18-24 months
