Testicular cancer

Question 1

Types

Answer 1

Seminomas

Non-seminomas (mostly teratomas)

Question 2

Risk factors

Answer 2

Undescended testes

Male infertility

Family history

Increased height

Klinefelter’s syndrome

Mumps orchitis

Question 3

Features

Answer 3

Painless lump (pain in minority of men)

Hydrocele

Gynaecomastia (increased oestrogen:androgen)

Question 4

Features of lump

Answer 4

Non-tender

Arising from testicle

Hard

Irregular

Non-fluctuant

No transillumination

Question 5

Investigations

Answer 5

Scrotal US is initial investigation

Tumour markers

Staging CT

Question 6

Tumour markers

Answer 6

Alpha-fetoprotein: raised in teratomas (not pure seminomas)

Beta-hCG: raised in both teratomas and seminomas

LDH: very non-specific tumour marker

Question 7

Royal marsden staging system

Answer 7

1: isolated to testicle

2: spread to retroperitoneal lymph nodes

3: spread to lymph nodes above the diaphragm

4: metastasised to other others

Question 8

Common places for testicular cancer to metastasise to

Answer 8

Lymphatics

Lungs

Liver

Brain

Question 9

Management

Answer 9

Surgery to remove affected testicle

Chemotherapy

Radiotherapy

Sperm banking

Follow up (monitor tumour markers and CT scans/ chest xrays)

Question 10

Prognosis

Answer 10

5 year survival 95% for seminomas if stage 1

5 year survival 85% for teratomas if stage 1