Testicular Cancer ☺️

Question 1

Epidemiology

Answer 1

Most common in 20-40s

Rapid progression

Question 2

Types

Answer 2

Most are germ cell tumours

• seminomas
• non seminomas

Non germ cell - Leydig cell tumours, sarcomas

Question 3

Risk factors

Answer 3

Infertility
Undescended testes
FHx
Klinefelters 
Mumps orchiditis

Question 4

Presentation

Answer 4

Painless lump
Hydrocele
Gynecomastia (increased O:A ratio)

Back pain - bony mets

Question 5

Investigations
Tumour markers
Diagnosis
-definitive
-staging

Answer 5

Bimanual testicular exam
Abdo exam - LN, supraclavicular LN

DEFINITIVE - US scrotum
-assess for blood supply, fluid, size, microlithiasis
STAGING - CXR/CT for staging

Tumour markers

• bHcG - seminoma, choriocarcinoma, embryonal
• LDH (assess tumour burden), -AFP - embryonal, teratoma, yolk sac
• FSH/LH/T

Question 6

Spread of testicular cancer

Answer 6

LN
Liver
Lung

Question 7

Management

-before surgery/treatment

Answer 7

Fertility/sperm banking
Testicular prosthesis

Radical orchidectomy

Treatment depends on seminoma/non seminoma
Seminoma - adjuvant radio
Non seminoma - surveillance, adjuvant chemo, retroperitoneal LN dissection depending on risk

Question 8

Possible differentials if not cancer

Answer 8

Testicular torsion - pain
Epididymitis/orchiditis - signs of infection
Hydrocele/spermatocele/varicocele - transillumination
Testicular rupture - pain, skin changes
Klinefelters - undescended testes