Week 138 - Testicular Lump Flashcards
What is Orchidopexy?
Surgery for undescended testicle
What does the Dartos Muscle do?
Responsible for wrinkling scrotum when cold
What does the Cremaster Muscle do?
Draws Testicles in - cold
Where does the arterial supply to testicle arise?
Testicular Arteries from Aorta at L2
What is the venous drainage of testicle?
Pampiniform Plexi to Lt Renal Vein (Left) & IVC (right)
What do Sertoli Cells do?
Epithelial cells of tubules
Acted on by FSH –> nourish sperm through development
What do Leydig Cells do?
Secrete testosterone (in response to LH)
What is Rete Testis?
Network of tubules where fluid reabsorbed & sperm concentrated
What is the arterial to the scrotum?
It is from Internal Pudendal Artery from Internal Iliac Artery
What is the likely cause of an acutely painful testicle in a 17 year old?
Testicular torsion (if no sexual/trauma history)
Where is a testicular tumour likely to metastasise?
Para-aortic nodes
What is the function of the Bulbo-urethral glands of Cowper?
Lubricate the Urethra
What is the commonest malignant tumour of testis?
Seminoma
What conditions do cryptorchid testis predispose an individual to?
Testicular Malignancy
Testicular Torsion
Inguinal Hernias
What do the secretions of the seminal vesicles contain?
Fructose, Vit C, prostaglandins, fibrinogen and vesiculase
What does the Prostate Produce?
Citric acid, acid phosphatase, fibrinolysin
What three cylinders does the penis consist of?
Corpora cavernosum (x2) - erectile vascular tissue Corpus Spongiosum - surrounds penile urethra + forms glans penis
What are the two main types of germ cell tumours in the testis?
Seminomas Nonseminomas (5 subtypes: teratomas, yolk sac tumour)
At whay age are Seminomas rare?
Before 10
Over 60
What are the risk factors for Testicular Germ Cell Tumours?
Cryptochidism Testicular Atrophy Inguinal Hernia Hydrocoele Syndromes with abnormal testicular development
What effect can mumps have on the testicles?
Atrophy
10% of men with germinal cell tumours have h/o mumps
What are the tumour markers that can be tested for in testicular cancer?
AFP, β-hCG, LDH
If AFP is elevated as a tumour marker, what type of tumour is that suggestive of?
Non-seminoma
What tumour marker is elevated in 30% of seminomas?
β-hCG
Where is β-hCG also produced?
Trophoblastic tissue in placenta
Upper GI, bladder and bronchial carcinomas
Apart from NSGCTs, what can AFP be a marker for?
Hepatocellular carcinoma
Are intra or extra testicular masses generally benign?
Intra testicular = gen. malignant
Extra testicular = gen. benign
What secondary tumours are likely to present as intra-testicular masses?
Lymphoma - older men
Leukaemia - children
What are the likely causes of Extra-testicular masses?
Hydrocoele Epididymal cysts Spermatocoele Varicocoele Epididymitis/ Orchitis
What is the chemotherapy used for the treatment of testicular cancer?
BEP (bleomycin, etoposide & cisplatin)
What is the mechanism of action of Cisplatin?
Form adducts with DNA leading to strand breaks
What is the mechanism of action of Etoposide?
Topoisomerase inhibitor
Name a few Antimicrotubule agents
Taxanes (paclitaxel, docetaxel)
Alkaloids (vincristine, vinblastine)
Name a few anthracyclines and what they do
Doxorubicin, Epirubicin
Intercalate in the DNA molecule -> block topoisomerase action
Name a few anti-metabolites and what they do
Fluorouracil - mimic uracil
Methotrexate - inhibits enzyme in folate synthesis
What is Trastuzumab?
Herceptin, acts on cErbB2 (HER2)
What receptor does Pertuzumab act on?
cErbB2 (HER2)
What receptor does Cetuximab act on?
EGFR
What does Bevacizumab (Avastin) act on?
VEGF
What is Imatinib?
TKI, BCR-Abl
What is neo-adjuvant therapy?
Therapy before radical local treatment
To reduce extent of surgery/ make surgery possible
What is adjuvant therapy?
After radical local treatment, to increase change of cure
What are the common toxic effects of chemotherapy?
Bone Marrow Toxicity (neutropenic sepsis, anaemia)
GI toxicity
Cardiac Toxicity (antracyclines, trastuzumab)
Pulmonary, Reproductive
What medication can be used to reduce the effects of cancer on bone?
Bisphosphonates (pamidronate, ibandronate, zoledronic acid)
RANK-ligand inhibitors (denosumab)
If patient has elevated PSA, abnormal DRE or both, what is the next step in management of the patient?
Test urine - to rule out UTI, repeat PSA
Refer to urologist (TRUSS and Biopsy)
What is the Gleason’s Pattern Scale useful for?
Staging prostate cancer (histologically)
Jelly Beans -> squashed jelly beans -> No structure
What are the treatments available for the treatment of prostate cancer?
Radical prostatectomy +/- hormone ablative therapy
Radical radiotherapy +/- hormone ablative therapy
Brachytherapy (internal radiotherapy)
What are the treatments available for men presenting with metastatic disease subsequent to prostate cancer?
Based on hormone dependence of prostate cancer
Orchidectomy
Anti-androgens
LHRH analogues
What is the effect of bisphosphonates on bone?
Inhibit osteoclast formation, migration & osteolytic activity
What area of the prostate does BPH arise from?
Transitional zone
What area of the prostate does prostate cancer most commonly arise from?
Peripheral zone
