Station 1 Flashcards
24 YO MAN. Lump In Testes
History
Lump
Duration
Change in Size
Previous Lumps
Associated Symptoms- Pain, Vomiting
History - Trauma, UTI, Sexual history, STI, LUTS, Bowel Symptoms
Red Flag Symptoms - WL, Change In Appetite, Cough/SOB, lower limb swelling
Risk Factors
Cryptorchidism, Subfertility, Prev Testicular Ca, FH of Testicular Ca, radiation exposure
?Completed Family
PMH, DH - ?Allergies, ?Anticoagulants
Examination
Any Congenital Abnormalities/ Gynaecomastia
Abdominal Examination - ? Retroperitoneal Mass
Examine for Supraclavicular Lymphadenopathy
Initial Investigations
USS Testes
CXR
Tumour Markers - AFP, bHCG, LDG, CEA, NSE
USS - Suggestive of Testicular Cancer
What Next
1) Inform Consultant
2) Inform patient with Testicular CNS Present
3) Request CT Chest, Book for urgent Radical Inguinal Orchidectomy (+/- Contralateral Biopsy), Sperm Banking (If required), Fertility Assessment, Semen Analysis
4) Counsel for prosthesis
Consent for Radical Orchidectomy
Bleeding Infection Pain
Cosmetic Apperances
Haematoma/Seroma
Benign Pathology
Chronic Pain/Numbness in groin
Further procedures - RPLN/Chemo/Radio
Subfertility/ Endocrine Dysfunction
Indications for CL Testis Biopsy
Testicular Vol <12 ml
History of Cryptoorchidism
Age <40
Immediate follow-up/further investigations after Radical Orchidectomy
Staging CT-TAP + MRI Brain
Histology discussed at MDT
Tumour Markers at 1/52 -> May need adjuvant chemo
Classify Testicular Tumours
Germ Cell (>90%)
Non-Seminomatous Germ cell
* Tumour Markers Raised in >90 % ( Any Tumour Marker)
* Teratoma, Choriocarcinoma, Embryonal, Yolk Sac
Seminoma
* Tumour Markers Raised in 5-10% (LDH and BHCG)
Non - Germ Cell (<10%)
Sertoli/Leydig
Other
Consider in older patients (I.e. Lymphoma)
Poor Prognostic Factors
Seminoma
Adjuvant Treatment
Tumour > 4 cm
Invasion of rete testis
Poor Prognostic Factors
Non-Seminomatous GCT
Adjuvant Treatment
MicroVascular or Lymphatic Invasion
Proliferation Rate High
High Embryonal Carcinoma content
