Testis Cancer Flashcards
How common is testis cancer?
Uncommon (1/200)
What is the typical age of incidence?
Age 15-45
What are the 2 broad categories of primary testicular tumours?
- Germ cell tumours (95%)
- Non-germ cell tumours (5%)
What are 2 different types of non-germ cell tumours?
- Leydig cell tumors
- Sertoli cell tumors
How does prognosis differ between germ cell & non-germ cell testicular tumours?
Germ cell tumours are usually malignant, whereas non-germ cell tumours (Leydig cell tumors or Sertoli cell tumors) are usually benign
How can germ cell tumours be divided?
- Seminomatous
- Non-seminomatous
- inc. embryonal, yolk sac, teratoma and choriocarcinoma
How does prognosis differ between seminomas & non-seminomas
Non-seminomas often metastasise early and have worse prognosis than seminoma.
Seminomas remain localised until late and have very good prognosis.
What are the risk factors for testis tumours?
- Infertility (Increases risk by 3x)
- Cryptorchidism (Undescended testes)
- 4-10x higher risk of GCTs
- Prev. testicular malignancy
- FHx
- Kleinfelter’s syndrome.
What is the typical presentation of testis cancer?
History
-
Young man presenting with unilateral painless testicular lump.
- May be painful sometimes
- Extratesticular manifestations
- Weight loss
- Back pain
- Dyspnoea
- Gynaecomastica
- Oedema
Examination
- Mass that is irregular, firm, fixed, and does not transilluminate.
- Supraclavicular nodes palpable sometimes
Why can back pain present as a symptoms of testicular cancer?
Due to development of retroperitoneal mets
Why can dyspnoea present as a symptom of testicular cancer?
Due to lung metastases
Why is there often no localised lymphadenopathy in testicular cancer, even in cases of metastatic disease?
Lymphatic drainage of testes is to para-aortic nodes, so may have no localised lymphadenopathy, even in cases of metastatic disease
What investigations would you carry out for suspected testicular cancer?
Diagnosis is made with tumour markers & imaging alone:
- . Scrotal USS (1st line)
* Initial assessment of scrotal lumps, alongside concurrent tumour markers - Tumour markers (used to establish both diagnosis and prognosis)
- ßHCG
- Elevated in 60% NSGCTs & 15% of seminomas
- AFP
- Elevated in some NSGCTs
- LDH
- Used as a surrogate marker for tumour volume.
- CT imaging with contrast of the chest-abdomen-pelvis.
* To stage cancer
Why should trans-scrotal percutaneous biopsy not be performed?
It might cause seeding of the cancer
How is testicular cancer staged?
Using the Royal Marsden Classification
What are the main treatment options for testicular cancer?
- Discussed in MDT to decide treatment options
- Surgery
- Radiotherapy
- Chemotherapy
The treatment of choice depends on the tumour type, risk scoring, and prognosis.
Surgery
- Inguinal radical orchidectomy (usually)
- Removes the testes along with the spermatic cord, allowing for maximal lymphatic system to be removed.
- Can put in prosthetic initially or at a later date
- Pre-treatment fertility assessment should be performed, and semen analysis and cryopreservation offered accordingly.
* For patients of reproductive age
Why is it important to provide pre-treatment fertility assessment aswell as semen analysis and cryopreservation to patients with testicular cancer?
Prior to treatment:
- Sperm abnormalities and Leydig cell dysfunction are frequently found in patients
After treatment
- Chemotherapy & radiotherapy can impair fertility.
What is the 1st line investigation for testicular cancer?
Doppler USS of testes
What is the prognosis for testicular cancers?
5 year survival:
- 95% for Stage I seminomas
- 85% for Stage I teratomas
When is the peak incidence for teratomas and seminomas respectively?
Teratomas = 25 yo
Seminomas = 35 yo
A patient has raised ß-HCG aswell as raised alpha-feto protein…
What is the most likely diagnosis & why?
Non-seminomatous testicular cancer
- Raised AFP excludes a seminoma
