Testicular Tumours

Question 1

What is the importance of testicular tumours?

Answer 1

Most common male malignant from 15-44 years

Question 2

What is the ratio of white:black in testicular tumour?

Answer 2

5:1

Question 3

How do testicular tumours present?

Answer 3

Painless testicular lump
Haematospermia
Symptoms of mets or lymph node involvement
Hormonal symptoms

Question 4

What presentation may occur secondary to a testicular tumour?

Answer 4

Hydrocele

Question 5

What symptoms of mets might be present with testicular tumours?

Answer 5

SOB from lung mets

Question 6

What symptoms of lymph node involvement may be present with testicular tumours?

Answer 6

Abdominal mass from para-aortic lymphadenopathy

Question 7

What hormonal symptoms may be present in testicular tumours?

Answer 7

Gynaecomastia

Virilisation

Question 8

What % of patients with testicular tumours have a contralateral tumour?

Answer 8

5%

Question 9

What are the risk factors for testicular tumours?

Answer 9

Undescended testis
Infant hernia
Infertility

Question 10

What % of testicular tumours occur in those with undescended testis?

Answer 10

10%

Question 11

What are the types of testicular tumours?

Answer 11

Germ cell tumours
Non-seminomas
Sex-cord stromal
Lymphoma/leukaemia

Question 12

What % of testicular tumours are germ cell tumours?

Answer 12

95%

Question 13

What are the types of germ cell testicular tumours?

Answer 13

Pure seminomas

Non-seminomas

Question 14

What % of germ cell testicular tumours are pure seminomas?

Answer 14

40%

Question 15

What age do pure seminoma germ cell testicular tumours present?

Answer 15

30-40

Question 16

What tumour markers may be raised in pure seminoma germ cell testicular tumours?

Answer 16

Incrased ßhCG in 15%

Increased placental ALP in some

Question 17

What is true of pure seminoma germ cell testicular tumours, regarding treatment?

Answer 17

They are very radiosensitive

Question 18

What are the types of non-seminoma germ cell testicular tumours?

Answer 18

Mixed
Teratoma
Yolk sac
Choriocarcinoma

Question 19

Where do testicular teratomas arise from?

Answer 19

All 3 germ cell layers

Question 20

How are testicular teratomas different depending on when they present?

Answer 20

They are common and benign in children, but rare and malignant in adults

Question 21

What tumour markers do testicular teratomas secrete?

Answer 21

ßhCG and/or AFP

Question 22

What is true of testicular teratomas, regarding treatment?

Answer 22

Chemosensitive

Question 23

What is the most common testicular tumour in children?

Answer 23

Yolk sac tumour

Question 24

What tumour marker is greatly increased in testicular choriocarcinoma?

Answer 24

ßhCG

Question 25

What are the types of sex-cord stromal testicular tumours?

Answer 25

Leydig cells | Sertoli cells

Question 26

What is true of the prognosis of Leydig cell tumours?

Answer 26

They are mostly benign

Question 27

What might Leydig cell tumours secrete?

Answer 27

Androgens or oestrogens

Question 28

What is true of the prognosis of Sertoli cell tumours?

Answer 28

They are mostly benign

Question 29

What may Sertoli cell tumours secrete?

Answer 29

Oestrogens

Question 30

What is the most common malignant testicular mass >60 years?

Answer 30

Non-hodgkins lymphoma

Question 31

What is the most common malignant testicular mass <5 years?

Answer 31

Acute lymphoblastic leukaemia

Question 32

What investigations are done in testicular tumours?

Answer 32

Tumour markers Scrotum US Staging

Question 33

What are tumour markers useful for in testicular tumours?

Answer 33

Monitoring

Question 34

What tumour markers may be raised in teratomas?

Answer 34

AFP and ßhCG

Question 35

What % of teratomas have raised AFP and ßhCG?

Answer 35

90%

Question 36

What % of seminomas have raised hCG?

Answer 36

15%

Question 37

What investigations are used for staging in testicular tumours?

Answer 37

CXR | CT

Question 38

Why should percutaneous biopsy not be performed in testicular tumours?

Answer 38

May get seeding along needle tract

Question 39

What can be done if both testes are abnormal, in order to allow patient to have kids?

Answer 39

Semen can be cryopreserved

Question 40

How are stage 1-2 seminomas managed?

Answer 40

Inguinal orchidectomy and radiotherapy

Question 41

How is seeding prevented during inguinal orchidectomy for seminoma?

Answer 41

Groin incision allows cord clamping to prevent seeding

Question 42

How are stage 3-4 seminomas managed?

Answer 42

Inguinal orchidectomy, radiotherapy, and chemotherapy

Question 43

What chemotherapy regime is used in stage 3-4 seminoma?

Answer 43

Bleomycin Etoposide Cisplain

Question 44

How are stage 1 non-seminomas/teratomas managed?

Answer 44

Inguinal orchidectomy and surveillance

Question 45

How are stage 2 non-seminomas/teratomas managed?

Answer 45

Orchidectomy + chemo + para-aortic lymph node dissection

Question 46

How are stage 3 non-seminomas/teratomas managed?

Answer 46

Orchidectomy and chemo

Question 47

What is involved in surveillance to detect relapse in testicular tumours?

Answer 47

Repeat CT scanning and tumour markers, typically within 18-24 months