Urological Malignancy - Testicular Cancer

Question 1

Risk Factors of Testicular Cancer (8).

Answer 1

1. Cryptorchidism.
2. Intersex Syndrome e.g. Gonadal Dysgenesis, AIS.
3. Family History.
4. Infertility.
5. Extra Copies of 12p (All Germ Cell Tumours).
6. Increased Height.
7. Mumps Orchitis.
8. Klinefelter’s Syndrome.

Question 2

Epidemiology of Testicular Cancer.

Answer 2

Commonest cancer in men aged between 15-29.

Question 3

Pathophysiology of Testicular Cancers.

Answer 3

1. 95% are Germ-Cell Tumours (germ cells of the testis develop into mature spermatozoa : germ cells - spermatogonia - spermatocytes - spermatids - spermatozoa).
2. Arise in seminiferous tubules of the testes.

Question 4

Types of Germ Cell Tumours.

Answer 4

1. Pure Seminomas.

2. Non-Seminomatous GCTs - Yolk Sac Tumours, Choriocarcinomas, Teratomas, Embryonal Carcinomas (more aggressive).

Question 5

Spread of Testicular Cancer.

Answer 5

Via lymphatics to para-aortic retroperitoneal lymph nodes.

Question 6

Clinical Features of Testicular Lump in Cancer (6).

Answer 6

1. Non-Tender.
2. Arising from Testicle.
3. Hard.
4. Irregular.
5. Non-Fluctuant.
6. Not-Transilluminating.

Question 7

Indications for Referral.

Answer 7

Any patient with a swelling or mass in the body of the testis should be referred urgently with the 2-week rule referral.

Question 8

Why can Gynaecomastia be a presentation of Testicular Cancers?

Answer 8

Especially with Leydig-Cell Tumours = increased Oestrogen : Androgen ratio.

Question 9

Investigations of Testicular Cancer.

Answer 9

1. Scrotal US Scan.

2. Serum Tumour Markers.

Question 10

Aetiology of Hydrocoele vs. Varicocoele.

Answer 10

Hydrocoele - Fluid building up inside Tunica Vaginalis Membrane.
Varicocoele - swelling of the Pampiniform Venous Plexus.

Question 11

Serum Tumour Markers (3).

Answer 11

1. Alpha Feto-Protein (raised in teratomas).
2. b-hCG (raised more in teratomas).
3. Lactate Dehydrogenase.

Question 12

Staging of Testicular Cancer.

Answer 12

Royal Marsden Staging System :-
Stage I - Isolated to Testicle.
Stage II - Spread to Retroperitoneal Lymph Nodes.
Stage III - Spread to Lymph Nodes Above Diaphragm.
Stage IV - Metastasis to Other Organs.

Question 13

Management of Testicular Cancer (2).

Answer 13

1. Seminomas - Radical Orchidectomy.

2. Teratomas - Chemotherapy + Radical Orchidectomy.