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Urology - Surgery > Testis Cancer > Flashcards

Testis Cancer Flashcards

1
Q

How common is testis cancer?

A

Uncommon (1/200)

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2
Q

What is the typical age of incidence?

A

Age 15-45

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3
Q

What are the 2 broad categories of primary testicular tumours?

A
  • Germ cell tumours (95%)
  • Non-germ cell tumours (5%)
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4
Q

What are 2 different types of non-germ cell tumours?

A
  • Leydig cell tumors
  • Sertoli cell tumors
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5
Q

How does prognosis differ between germ cell & non-germ cell testicular tumours?

A

Germ cell tumours are usually malignant, whereas non-germ cell tumours (Leydig cell tumors or Sertoli cell tumors) are usually benign

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6
Q

How can germ cell tumours be divided?

A
  • Seminomatous
  • Non-seminomatous
    • inc. embryonal, yolk sac, teratoma and choriocarcinoma
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7
Q

How does prognosis differ between seminomas & non-seminomas

A

Non-seminomas often metastasise early and have worse prognosis than seminoma.

Seminomas remain localised until late and have very good prognosis.

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8
Q

What are the risk factors for testis tumours?

A
  • Infertility (Increases risk by 3x)
  • Cryptorchidism (Undescended testes)
    • 4-10x higher risk of GCTs
  • Prev. testicular malignancy
  • FHx
  • Kleinfelter’s syndrome.
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9
Q

What is the typical presentation of testis cancer?

A

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
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10
Q

Why can back pain present as a symptoms of testicular cancer?

A

Due to development of retroperitoneal mets

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11
Q

Why can dyspnoea present as a symptom of testicular cancer?

A

Due to lung metastases

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12
Q

Why is there often no localised lymphadenopathy in testicular cancer, even in cases of metastatic disease?

A

Lymphatic drainage of testes is to para-aortic nodes, so may have no localised lymphadenopathy, even in cases of metastatic disease

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13
Q

What investigations would you carry out for suspected testicular cancer?

A

Diagnosis is made with tumour markers & imaging alone:

  1. . Scrotal USS (1st line)
    * Initial assessment of scrotal lumps, alongside concurrent tumour markers
  2. 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.
  1. CT imaging with contrast of the chest-abdomen-pelvis.
    * To stage cancer
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14
Q

Why should trans-scrotal percutaneous biopsy not be performed?

A

It might cause seeding of the cancer

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15
Q

How is testicular cancer staged?

A

Using the Royal Marsden Classification

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16
Q

What are the main treatment options for testicular cancer?

A
  1. 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
  1. Pre-treatment fertility assessment should be performed, and semen analysis and cryopreservation offered accordingly.
    * For patients of reproductive age
17
Q

Why is it important to provide pre-treatment fertility assessment aswell as semen analysis and cryopreservation to patients with testicular cancer?

A

Prior to treatment:

  • Sperm abnormalities and Leydig cell dysfunction are frequently found in patients

After treatment

  • Chemotherapy & radiotherapy can impair fertility.
18
Q

What is the 1st line investigation for testicular cancer?

A

Doppler USS of testes

19
Q

What is the prognosis for testicular cancers?

A

5 year survival:

  • 95% for Stage I seminomas
  • 85% for Stage I teratomas
20
Q

When is the peak incidence for teratomas and seminomas respectively?

A

Teratomas = 25 yo

Seminomas = 35 yo

21
Q

A patient has raised ß-HCG aswell as raised alpha-feto protein…

What is the most likely diagnosis & why?

A

Non-seminomatous testicular cancer

  • Raised AFP excludes a seminoma

Urology - Surgery (12 decks)

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