Week 138 - Testicular Lump

Question 1

What is Orchidopexy?

Answer 1

Surgery for undescended testicle

Question 2

What does the Dartos Muscle do?

Answer 2

Responsible for wrinkling scrotum when cold

Question 3

What does the Cremaster Muscle do?

Answer 3

Draws Testicles in - cold

Question 4

Where does the arterial supply to testicle arise?

Answer 4

Testicular Arteries from Aorta at L2

Question 5

What is the venous drainage of testicle?

Answer 5

Pampiniform Plexi to Lt Renal Vein (Left) & IVC (right)

Question 6

What do Sertoli Cells do?

Answer 6

Epithelial cells of tubules

Acted on by FSH –> nourish sperm through development

Question 7

What do Leydig Cells do?

Answer 7

Secrete testosterone (in response to LH)

Question 8

What is Rete Testis?

Answer 8

Network of tubules where fluid reabsorbed & sperm concentrated

Question 9

What is the arterial to the scrotum?

Answer 9

It is from Internal Pudendal Artery from Internal Iliac Artery

Question 10

What is the likely cause of an acutely painful testicle in a 17 year old?

Answer 10

Testicular torsion (if no sexual/trauma history)

Question 11

Where is a testicular tumour likely to metastasise?

Answer 11

Para-aortic nodes

Question 12

What is the function of the Bulbo-urethral glands of Cowper?

Answer 12

Lubricate the Urethra

Question 13

What is the commonest malignant tumour of testis?

Answer 13

Seminoma

Question 14

What conditions do cryptorchid testis predispose an individual to?

Answer 14

Testicular Malignancy
Testicular Torsion
Inguinal Hernias

Question 15

What do the secretions of the seminal vesicles contain?

Answer 15

Fructose, Vit C, prostaglandins, fibrinogen and vesiculase

Question 16

What does the Prostate Produce?

Answer 16

Citric acid, acid phosphatase, fibrinolysin

Question 17

What three cylinders does the penis consist of?

Answer 17

Corpora cavernosum (x2) - erectile vascular tissue
Corpus Spongiosum - surrounds penile urethra + forms glans penis

Question 18

What are the two main types of germ cell tumours in the testis?

Answer 18

Seminomas
Nonseminomas (5 subtypes: teratomas, yolk sac tumour)

Question 19

At whay age are Seminomas rare?

Answer 19

Before 10

Over 60

Question 20

What are the risk factors for Testicular Germ Cell Tumours?

Answer 20

Cryptochidism
Testicular Atrophy
Inguinal Hernia
Hydrocoele
Syndromes with abnormal testicular development

Question 21

What effect can mumps have on the testicles?

Answer 21

Atrophy

10% of men with germinal cell tumours have h/o mumps

Question 22

What are the tumour markers that can be tested for in testicular cancer?

Answer 22

AFP, β-hCG, LDH

Question 23

If AFP is elevated as a tumour marker, what type of tumour is that suggestive of?

Answer 23

Non-seminoma

Question 24

What tumour marker is elevated in 30% of seminomas?

Answer 24

β-hCG

Question 25

Where is β-hCG also produced?

Answer 25

Trophoblastic tissue in placenta | Upper GI, bladder and bronchial carcinomas

Question 26

Apart from NSGCTs, what can AFP be a marker for?

Answer 26

Hepatocellular carcinoma

Question 27

Are intra or extra testicular masses generally benign?

Answer 27

Intra testicular = gen. malignant | Extra testicular = gen. benign

Question 28

What secondary tumours are likely to present as intra-testicular masses?

Answer 28

Lymphoma - older men | Leukaemia - children

Question 29

What are the likely causes of Extra-testicular masses?

Answer 29

``` Hydrocoele Epididymal cysts Spermatocoele Varicocoele Epididymitis/ Orchitis ```

Question 30

What is the chemotherapy used for the treatment of testicular cancer?

Answer 30

BEP (bleomycin, etoposide & cisplatin)

Question 31

What is the mechanism of action of Cisplatin?

Answer 31

Form adducts with DNA leading to strand breaks

Question 32

What is the mechanism of action of Etoposide?

Answer 32

Topoisomerase inhibitor

Question 33

Name a few Antimicrotubule agents

Answer 33

Taxanes (paclitaxel, docetaxel) | Alkaloids (vincristine, vinblastine)

Question 34

Name a few anthracyclines and what they do

Answer 34

Doxorubicin, Epirubicin | Intercalate in the DNA molecule -> block topoisomerase action

Question 35

Name a few anti-metabolites and what they do

Answer 35

Fluorouracil - mimic uracil | Methotrexate - inhibits enzyme in folate synthesis

Question 36

What is Trastuzumab?

Answer 36

Herceptin, acts on cErbB2 (HER2)

Question 37

What receptor does Pertuzumab act on?

Answer 37

cErbB2 (HER2)

Question 38

What receptor does Cetuximab act on?

Answer 38

EGFR

Question 39

What does Bevacizumab (Avastin) act on?

Answer 39

VEGF

Question 40

What is Imatinib?

Answer 40

TKI, BCR-Abl

Question 41

What is neo-adjuvant therapy?

Answer 41

Therapy before radical local treatment | To reduce extent of surgery/ make surgery possible

Question 42

What is adjuvant therapy?

Answer 42

After radical local treatment, to increase change of cure

Question 43

What are the common toxic effects of chemotherapy?

Answer 43

Bone Marrow Toxicity (neutropenic sepsis, anaemia) GI toxicity Cardiac Toxicity (antracyclines, trastuzumab) Pulmonary, Reproductive

Question 44

What medication can be used to reduce the effects of cancer on bone?

Answer 44

Bisphosphonates (pamidronate, ibandronate, zoledronic acid) | RANK-ligand inhibitors (denosumab)

Question 45

If patient has elevated PSA, abnormal DRE or both, what is the next step in management of the patient?

Answer 45

Test urine - to rule out UTI, repeat PSA | Refer to urologist (TRUSS and Biopsy)

Question 46

What is the Gleason's Pattern Scale useful for?

Answer 46

Staging prostate cancer (histologically) | Jelly Beans -> squashed jelly beans -> No structure

Question 47

What are the treatments available for the treatment of prostate cancer?

Answer 47

Radical prostatectomy +/- hormone ablative therapy Radical radiotherapy +/- hormone ablative therapy Brachytherapy (internal radiotherapy)

Question 48

What are the treatments available for men presenting with metastatic disease subsequent to prostate cancer?

Answer 48

Based on hormone dependence of prostate cancer Orchidectomy Anti-androgens LHRH analogues

Question 49

What is the effect of bisphosphonates on bone?

Answer 49

Inhibit osteoclast formation, migration & osteolytic activity

Question 50

What area of the prostate does BPH arise from?

Answer 50

Transitional zone

Question 51

What area of the prostate does prostate cancer most commonly arise from?

Answer 51

Peripheral zone