Week 9: Germ cell tumours Flashcards
How might testicular cancer present
- Painless solid enlargement
- Decrease in testicular size
- Scrotal pain (dragging sensation)
- Hydrocele
- Gynaecomastia
Does testicular cancer present early or late
Late
Differential diagnosis for a testicular mass
- Cancer
- Benign epididymal mass (common)
- Orchitis/ epididymo-orchitis
- Infiltration from lymphoma/ leukaemia
Which elevated tumour markers, in conjuction with a testicular mass, is highly suggestive of testicular cancer
- AFP
2. beta hCG
What investigations should be done for testicular cancer
- Tumour markers (AFP and b-hCG)
- Scrotal USS
- CXR
- CT chest, abdo, pelvis
When would you do a CT brain in a pt with testicular cancer
- Multiple lung mets
2. b-hCG >10,000
Why do pts with high b-hCG have a risk of getting thyrotoxicosis
b-hCG is similar in structure to TSH
Where is b-hCG formed in body
Syncytiotrophoblast (in placenta)
What type of tumours is b-hCG elevated in
- Germ cell tumours
2. Gestational trophoblastic disease
Where is AFP formed in body
- Liver
- Intestine
- Foetal yolk sac
What type of tumours is AFP elevated in (2 most impt)
Most impt :
- Teratomas
- Hepatocarcinoma
Others:
- Pancreatic cancer
- Biliary cancer
- Gastric cancer
- Bronchial cancer
- Non-malignant liver disease
Approximately how long after surgery should AFP and b-hCG take to normalise
b-hCG: 24h
AFP: 4-6 days
AFP has a longer half life so takes longer to normalise
What type of tumours is Lactate Dehydrogenase elevated in
Any rapid-growing tumour (indicates that necrosis is occurring)
Seminoma/ Teratoma has a more predictable lymphatic spread
Seminoma has a more predictable lymphatic spread
Seminoma/ Teratoma is more commonly spread through blood
Teratoma is more commonly spread through blood
In local spread of testicular cancer, where are the mets found
Rete testis (in both types of testicular cancer)
Most common site that a blood-spread testicular tumour goes to
Lungs
Which chromosomal syndromes are associated with a higher risk of testicular cancer
- Klinefelter’s syndrome
* Down’s syndrome
Complications of local/ distal mets in testicular cancer
- SVC obstruction
- Ureteric obstruction
- Pleural effusion
- Lung, brain, liver mets
Paraneoplastic complications of testicular cancer
- Pulmonary emboli
2. Tumour lysis syndrome
How are the levels of the following in blood changed in tumour lysis syndrome
- uric acid
- K+
- Ca2+
- phosphate
- uric acid HIGH
- K+ HIGH
- Ca2+ LOW
- phosphate HIGH
How does tumour lysis syndrome affect the heart/vascular system
- Cardiac arrest, arrhythmias (due to high K+, low Ca2+)
- Intravascular haemolysis (due to high LDH)
- More clots (activation of coagulation cascades)
How does tumour lysis syndrome affect the kidney
Urate nephropathy (due to high uric acid in blood)
Do teratomas or seminomas have a higher relapse rate
Teratomas
What type of secondary malignancy has an increased risk with radiotherapy
Solid organ malignancy
What type of secondary malignancy has an increased risk with chemotherapy
Haemotological malignancy
What 3 drugs are given as adjuvant chemotherapy in testicular cancer
- Bleomycin
- Etoposide
- Cisplatin
Complications of Bleomycin
- Pneumonitis
2. Pulmonary fibrosis
Complications of Cisplatin
- Renal impairment
- Neuropathy, high tone hearing loss
- Vomiting
- Increased risk of MI, stroke
Do males or females have more fertility complications after treatment for germ cell tumours
Females
Which tumour marker is particularly associated with SEMINOMA
b-hCG
Which tumour marker is particularly associated with EMBRYONAL CARCINOMA
b-hCG + AFP
Which tumour marker is particularly associated with YOLK SAC TUMOUR
AFP
Which tumour marker is particularly associated with CHORIOCARCINOMA
b-hCG
Describe how a seminoma will mets
- mode
- route
Lymphatics
para-aortic nodes -> pelvic nodes -> mediastinal nodes
Which cancer has transcolemic spread?
Where to?
Ovarian cancer
Spread to lung liver bone
False positive for hCG
Cannabis
False positive for AFP
Alcohol abuse
Features of tumour lysis syndrome
-electrolytes
High uric acid
High postassium
High phosphate
Low calcium