Testicular Cancer

Question 1

Testicular cancer can originate in 3 main places. Which of the following is most common?

1 - non-germ cell
2 - germ cell
3 - secondary metastasis

Answer 1

2 - germ cell

Question 2

Which cells does testicular cancer originate from in the testicles?

1 - germ cells
2 - spermatic cord cells
3 - epididymal cells
4 - semen cells

Answer 2

1 - germ cells
- these cells produce gametes
- leydig cells produce testosterone

Question 3

What age group is testicular cancer most common in?

1 -5-15
2 - 15-35
3 - 30-50
4 - 65-80

Answer 3

2 - 15-35
- common in young men

Question 4

Inside the testicles there are lobules that contain up to 4 seminiferous tubules, which are where sperm is made. What are the cells on the outside of the seminiferous tubules called?

1 - gametes
2 - germ cells
3 - sertoli cells
4 - leydig cells

Answer 4

2 - germ cells
- these will form male gametes
- the germ cells are the most common site for testicular cancer formation

Question 5

The germ cells can forma variety of different tumours. Which of the following is the most common?

1 - teratoma
2 - yolk sac tumour
3 - seminoma
4 - choriocarcinoma

Answer 5

3 - seminoma
- large cells with central nuclei
- surrounded by fibrous tissue separates the seminoma from the health germ cells
- fibrous tissue always contains lymphocytes

Question 6

What enzymes can be commonly produced by seminomas that can be helpful when trying to diagnose the seminomas?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 6

3 - Placental Alkaline Phosphotase (PLAP)
- typically produced by the placenta

Question 7

Yolk sac tumours are germ cells that have differentiated into yolk sac tissue. What age are these most common in?

1 - young children
2 - middle aged adults
3 - older adults
4 - elderly adults

Answer 7

1 - young children
- very aggressive tumours

Question 8

Yolk sac tumours are germ cells that have differentiated into yolk sac tissue and are the most commonly found in young children. Under a microscope they form Schiller-Duval bodies, which are rings of malignant cells around the blood vessel. What do these secrete that can be a useful marker?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 8

1 - Alpha Fetoprotein
- typically secreted by the yolk sac and fetal liver in pregnancy
- this resembles albumin in the blood

Question 9

Choriocarcinoma are seminoma tumours that originate from germ cells. The germ cells then differentiate into which 2 type of cells?

1 - leydig cells
2 - sertoli cells
3 - syncytiotrophoblasts
4 - cytotrophoblasts

Answer 9

3 - syncytiotrophoblasts
4 - cytotrophoblasts

Question 10

Choriocarcinoma are seminoma tumours that originate from germ cells, which differentiate into syncytiotrophoblasts and cytotrophoblasts that typically help form the placenta. They are typicall small and invade local blood vessels, leading to bleeding. What do the Choriocarcinomas secrete that can be useful when diagnosing these tumours?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 10

2 - Beta human chorionic gonadotropin (HCG)

• these cells produce HCG during pregnancy and is what is detected in a pregnancy test

Question 11

Which of the following is NOT a risk factors for testicular cancer?

1 - Cryptorchidism (Undescended testes)
2 - Male infertility
3 - Family history
4 - Increased height
5 - Smoking

Answer 11

5 - Smoking

Question 12

All of the following are risk factors for risk factors for testicular cancer, but which is the largest risk factor?

1 - Cryptorchidism (Undescended testes)
2 - Male infertility
3 - Family history
4 - Increased height

Answer 12

1 - Cryptorchidism (Undescended testes)
- the testes fail to descend of get stuck in the inguinal canal

Question 13

Which 2 cells do non germ cell testicular cancers come from?

1 - leydig cells
2 - sertoli cells
3 - syncytiotrophoblasts
4 - cytotrophoblasts

Answer 13

1 - leydig cells
2 - sertoli cells

Question 14

Are the non germ cell testicular cancers that originate from sertoli cells dangerous?

Answer 14

• no
• rare, benign and generally do not produce any hormones
• typically located inside the seminiferous tubules

Question 15

Non germ cell testicular cancers that originate from leydig cells originate from outside the seminiferous tubules. They are hormonally active and able to secrete male and female hormones. Excessive testosterone causes which of the following?

1 - gynaecomastia
2 - premature puberty
3 - feminisation
4 - testicular atrophy

Answer 15

2 - premature puberty

Question 16

Non germ cell testicular cancers that originate from leydig cells originate from outside the seminiferous tubules. They are hormonally active and able to secrete male and female hormones. Excessive estrogen can cause all of the following in adults EXCEPT which one?

1 - gynaecomastia
2 - premature puberty
3 - feminisation
4 - testicular atrophy
5 - erectile dysfunction
6 - reduced libido

Answer 16

2 - premature puberty
- look for Reinke crystals on histology

Question 17

What symptoms are common in patients with testicular cancer?

1 - testicular mass
2 - testicular/abdominal swelling
3 - dull or sharp pain in testicles and abdomen
4 - all of the above

Answer 17

4 - all of the above
- if it metastases this can spread to the lungs and cause dyspnoea and haemoptysis

Question 18

Which of the following hormones is not typically quantified to identify a testicular tumours?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Growth hormone
4 - Lactate dehydrogenase

Answer 18

3 - Growth hormone

Question 19

What is the 1st imaging modality used in testicular cancer?

1 - MRI
2 - CT KUB
3 - scrotal ultrasound
4 - X-ray

Answer 19

3 - scrotal ultrasound
- staging will be performed using a CT scan

Question 20

If the testicular cancer spreads, which lymph nodes do they spread into?

1 - lumbar lymph nodes
2 - retroperitoneal lymph nodes
3 - inguinal lymph nodes
4 - pelvic lymph nodes

Answer 20

2 - retroperitoneal lymph nodes
- this can lead to lower back pain