Urology: Testicular cancer Flashcards
State 4 risk factors for testicular cancer [4]
Undescended testes
Male infertility
Family history
Increased height
Klinefelters syndrome
HIV infection
Infant hernia
Describe the difference classes of testicular cancer [4]
Germ cell tumours (95% of cancers):
- Seminomas
- Non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma
Non-germ cell tumours:
- include Leydig cell tumours and sarcomas.
Describe the difference in common age of patients between seminomas and teratomas [2]
Describe the difference in aggressiveness between seminomas and teratomas [2]
Seminomas: 35-40 year olds; less aggressive
Teratomas: 20-35 year olds; more aggressive
Teratoma: troops; seminoma: seargents
Describe clinical presentation of testicular cancer [4]
- A painless lump is the most common presenting symptom
- Pain may also be present in a minority of men
- Other possible features include hydrocele, gynaecomastia (drastic level of β-hCG)
- Haematospermia
Name 3 tumour serum markers used to investigate in testicular cancer [3]
AFP is elevated in around 60% of germ cell tumours
LDH is elevated in around 40% of germ cell tumours
Seminomas: hCG may be elevated in around 20%
What is first line investigation for testicular cancer? [1]
What is second line investigation for testicular cancer used for staging? [1]
1st: USS
2nd: CT - staging
Describe the managment for testicular cancer? [2]
Radical inguinal orchidectomy (remove testicle through inguinal canal; not through the scrotum; want to prevents letting cancer cells go into the para-aortic lymph nodes, which drain the testes)
Adjuvant chemotherapy
AFP is raised in which type of testicular cancer? [1]
AFP is not raised in which type of testicular cancer? [1]
BhCG is raised in which type of testicular cancer? [1]
BhCG is not raised in which type of testicular cancer?
Alpha-fetoprotein:
May be raised in teratomas
Not raised in pure seminomas
B-hCG:
May be raised in both
The common places for testicular cancer to metastasise to are? [4]
The common places for testicular cancer to metastasise to are:
Lymphatics
Lungs
Liver
Brain
LLLBean
Prognosis for testicular cancer? [2]
The prognosis for early testicular cancer is good, with a greater than 90% cure rate.
Metastatic disease is also often curable
Describe the treatment for metastatic testicular cancer [3]
Chemotherapy:
- Cisplatin & Etoposide (cornerstone)
- Bleomycin (added)
Describe 4 different stages of testicular cancer [4]
What is liquefaction time? [1]
How long should it normally take in men? []
Time taken for semen to liquify after ejacilation
Semen should liquefy within 20 to 30 minutes of ejaculation
Why may an increased liquify time be problematic? [1]
If too high, it means the sperm may be unable to make the jump to the cervix. It can be caused by infection and dehydration.
Name and explain which organ is responsible for liquefaction [2]
Prostate as it secretes a milky white fluid which contains prostate specific antigen (PSA). PSA is responsible for liquefaction
Label the abnormality pictured in A [1]
Bell clapper: (horizontal testes that lie high in scrotum),
Describe the presentation of testicular torsion [5]
- bell clapper’ position
- sudden-onset, sharp, severe, unilateral testicular pain
- absent cremasteric reflex
- negative Prehn’s sign (pain that is unrelieved by elevating the affected testis)
- swollen, tender and erythematous scrotal skin, may also be seen on examination.
What is this testicular abnormality? [1]
Hydrocele
Describe the pathophysiology of hydrocele [4]
collection of fluid within the tunica vaginalis that surrounds the testes due to patent processus vaginalis or secondary to trauma, torsion or infection
How do you investigate for hydrocele? [1]
Transilluminated: by shining torch through the skin, into the fluid (the testicle floats within the fluid)
Name this testicular abnormality and how it occurs [2]
Varicocele
- pampiniform plexus become swollen
- result of increased resistance in the testicular vein
State a serious cause of left sided variocele [1]
A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.
State 2 implications of variocele [2]
testicular atrophy, reducing the size and function of the testicle
Can lead to impaired fertility (probably due to disrupting the temperature in the affected testicle)
Explain what indicates that a variocele warrants further investigation? [1]
Varicoceles that do not disappear when lying down raise concerns about retroperitoneal tumours obstructing the drainage of the renal vein.
What does this image depict? [1]
Epididymal Cyst
What causes epididymo-orchitis? [4]
Inflammation of the epididymis and/or testicle:
- Chlamydia
- E. coli
- N. gon
- Mumps
- TB
How do you investigate epididymo-orchitis?(
First catch urine sample
Consider UTI screen
What is a positive Prehn’s sign? [1]
Which two pathologies does it help to distinguish between? [2]
+ve Prehn’s sign:
- the relief of pain on elevation of the testis
- Positive: indicates epididymo-orchitis
- Negative (i.e. the pain is not relieved) in cases of testicular torsion.
A 45-year-old man presents with symptoms of urinary colic. In the history he has suffered from recurrent episodes of frank haematuria over the past week or so. On examination he has a left loin mass and a varicocele. The most likely diagnosis is:
Renal adenocarcinoma
Renal cortical adenoma
Squamous cell carcinoma of the renal pelvis
Retroperitoneal fibrosis
Nephroblastoma
A 45-year-old man presents with symptoms of urinary colic. In the history he has suffered from recurrent episodes of frank haematuria over the past week or so. On examination he has a left loin mass and a varicocele. The most likely diagnosis is:
Renal adenocarcinoma
Renal cortical adenoma
Squamous cell carcinoma of the renal pelvis
Retroperitoneal fibrosis
Nephroblastoma
Which is a key differential when suspect appendicitis (in men)? [1]
testicular problems (infection and torsion).
Describe the management of testicular torsion [3]
Explore with surgial exploration: if positive undergo bilateral orchidopexy:
- the cord and testis will be untwisted and both testicles fixed to the scrotum,
- Occurs bilaterally even if presenting with one testicle torsion is because around 90% of cases are caused by a bell-clapper deformity and most of the patients with this deformity have it bilaterally. Bilateral fixation, therefore, reduces the risk of torsion in the other testis.
The first-line investigation of a testicular mass is []
The first-line investigation of a testicular mass is an ultrasound
Describe which parameters of varicoceles determine if treatment is given [2]
Grade II or III varicocoele Management:
* Asymptomatic AND normal semen parameters Semen analysis every 1-2yrs
* Symptomatic OR abnormal semen parameters: Surgery
nvestigations for suspected epididymo-orchitis are guided by age:
sexually active younger adults: []
older adults with a low-risk sexual history: []
nvestigations for suspected epididymo-orchitis are guided by age:
sexually active younger adults: NAAT for STIs
older adults with a low-risk sexual history: MSSU
Label the tumour marker for each type of testicular cancer [4]
A: hCG & AFP
B: AFP
C: hCG
D: no rise
