Urology - testicular cancer Flashcards
What are the two types of testicular cancer?
Seminomas
Non-seminomas
Risk factors for testicular cancer
Undescended testes
Male infertility
Family history
Increased height
Presentation of testicular cancer
Typically a painless lump (but can present with pain)
Lump will be:
- Non-tender (or even reduced sensation)
- Arising from testicle
- Hard and irregular
- Not fluctuant, no transillumination
Can also get gynaecomastia - so ask about this
- Associated with a rare type of testicular cancer called Leydig cell tumour
- Only 2% of gynaecomastia is testicular tumour
Investigations in suspected testicular tumour
2WW referral
Scrotal ultrasound - usual initial investigation
Tumour markers:
- AFP - raised in teratomas (not in pure seminomas)
- Beta-HCG - can be raised in both teratomas and seminomas
- LDH - non-specific
Staging CT scan to stage the cancer and look for metastases
What is the Staging System used for testicular cancer?
Royal Marsden staging system
Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs
Common places that testicular cancer metastasises to?
Lymphatics
Lungs
Liver
Brain
Management of testicular cancer
2WW referral
MDT discussion to decide best course of action
Options include:
- Surgery to removal testicle (radical orchidectomy)
- Chemotherapy
- Radiotherapy
- Sperm banking to save sperm for future use (treatment can cause infertility)
Side effects of treatment of testicular cancer
Infertility Hypogonadism (testosterone replacement may be required) Peripheral neuropathy Hearing loss Lasting kidney, liver or heart damage Increased risk of cancer in the future
Prognosis of testicular cancer
Good prognosis
> 90% cure rate and metastatic disease is also often curable
Patients will need regular follow-up for recurrence - usually by monitoring tumour markers and may include imaging e.g. CT
