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Revision Cards > Week 138 - Testicular lump > Flashcards

Week 138 - Testicular lump Flashcards

1
Q

What is the most common testicular cancer type and why does it represent the model of a curable malignancy?

A

Testicular Germ Cell Tumours
95% of testicular malignancies.

  • Sensitive tumour markers.
  • Accurate prognosis classification.
  • Logical series of management trials.
  • High cure rates in both seminomas and non-seminomas.
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2
Q

What are the two main types of germ cell testicular tumours?

A

1) Seminoma
2) Non-seminoma (Further divided into 5 subsets)

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3
Q

What cancer is the most common solid neoplasm in young men (aged 20-34yrs) and the second most common in men aged 35-40?

A

Testicular cancer,

Germ Cell Testicular Tumour

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4
Q

At what ages are seminomas rare?

A

Under 10 and over 60.

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5
Q

Give five risk factors for developing Germ Cell Testicular Tumour.

A

1) Cryptochidism
2) Testicular Atrophy
3) Inguinal Hernia
4) Hydrocele
5) Syndromes with abnormal testicular development

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6
Q

What is CIS testes?

A

• Carnicoma in situ of testes •

  • 50% develop invasive cancer at 5 years.
  • Spontaneous disappearance is never observed.
  • If left untreated will probably be invasive in all cases.
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7
Q

What is the clinical presentation of testicular cancer?

A
  • Painless swelling of testes.
  • 30-40% dull ache or heaviness.
  • 10% have acute testicular pain.
  • Enlargement in an atrophic teste.
  • 5% gynaemastica.
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8
Q

What are the investigations used to diagnose testicular cancer?

A
  • Examination
  • USS
  • MRI (High specificity but expensive)
  • Serum tumour markers
  • Orchidectomy
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9
Q

Which tumour markers are tested for in testicular cancer?

A
  • AFP - Raised in 50-70% of NSGCT, but not raised in pure seminomas.
  • ß-hCG - Raised in 40-60% of NSGCT and 30% of seminomas.
  • LDH is less specific but more commonly raised in seminomas.
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10
Q

What is Alpha-FP? What is it a marker of?

A

It is a tumour marker and an embryonal protein.

  • Not produced in pure seminomas, but can be produced by NSGCT.
  • Also produced in liver damage and is a marker of hepatocellular carcinoma.
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11
Q

What is ß-hCG? What is it a marker of?

A
  • It is a product of trophoblastic tissue in placaenta.
  • Also used as a tumour marker and is produced by both seminomas and non-seminomas.
  • Also produced by upper GI, bladder and bronchial carcinoma.
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12
Q

How does the staging work for testicular cancer?

A

• pT (Primary Tumour) •

  • pT0 - No evidence of tumour
  • pTis - In situ carcinoma
  • pT1 - Limited to testis and epididymis
  • pT2 - Limited to testis and epididymis with invasion into vascular/lymphatic invasion.
  • pT3 - Invades spermatic cord
  • pT4 - Invades scrotum
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13
Q

What is the management of a stage I seminoma?

A
  • Orchidectomy
  • 15-20% will have sub-clinical metastases in the retro-peritoneum so will relapse.
  • Adjuvant radiotherapy.
  • Surveilance.
  • Adjuvant Chemotherapy.
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14
Q

What are the common types of extra-testicular mass?

A

Usually benign.

  • Hydrocele
  • Spermatocele
  • Varicocoele
  • Epididymal cyst
  • Epididymtis/orchitis
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15
Q

Where do testicular tumour metastasise to?

A

Para-aortic

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16
Q

Which nodes are involved in advanced penile cancer?

A

Inguinal nodes.

17
Q

What is the chemotherapy used for testicular cancer and what is the cure rate?

A

BEP - bleomycin, etoposide and cisplantin.

Cures 90% of patients.

18
Q

What is the mechanism of most chemotherapy drugs and how does this affect cancer cells?

A

They interfere with DNA synthesis or cell replication.

Tumour cells rapidly divide, therefore are most susceptible to this effect, though the theraputic window is often very narrow.

19
Q

What are alkylating agents?

A

These are chemotherapy drugs that for covalent bonds with DNA, preventing DNA replication.

E.g- Mechloratamine, Cyclophosphamide, ifosfamide, melphalen.

20
Q

Hormone treatment is one of the most important therapies for which type of cancer?

A

• Breast cancer, anti-oestrogens are used as oestrogens have been shown to cause the growth of breast cancer.

21
Q

What are the four aims of systemic therapy of cancer?

A

• Primary therapy for curative therapy
- testicular cancer, ALL, Hodgkins lymphoma.

• Neo-adjuvant-
- To reduce the extent of surgery, e.g. breast, bladder, larynx.

• Adjuvent- Therapy after local radical treatment.
- Breast, colon, lung, prostate

• Management of advanced disease -
- Prolonging survival, paliative.

22
Q

What are the three branches for systemic therapy of cancer?

A

1) Stop proliferation - cytotoxic drugs.
2) Block growth signals - Anti-hormones, targeted treatment.

3) Prevent/reduce complications and side-effects.
- Support
- Anti-emetics
- Treatment of bone disease

23
Q

What is the most commonly diagnosed cancer in males?

A

• Prostate cancer.

24
Q

What is the 5 and 10 year survival from prostate cancer?

A
  • 5 yr - >8 in 10
  • 10 yr - nearly 7 in 10
25
Q

What is the link between disease stage at diagnosis and survival from prostate cancer?

A

Organ-contained disease - 90% at 5 yr

Metastatic - 30% at 5 yr

26
Q

What are the risk factors for developing prostate cancer?

A

• Age (increases exponentially after 50)

• Race (highest in europe and north america)

• Family History

  • Dietary fat intake
  • Hormones
27
Q

What are the symptoms for prostate cancer?

A
  • Often very little in early disease, symptoms are often indicative of advanced or metastatic disease.
  • Local - Obstructive voiding, Irritative symptoms, Blocked ejaculatory ducts, Impotence.
  • Metastatic - Bony pain, Anaemia, Lymphodema, Renal failure.
28
Q

What is the clinical utility of a PSA result?

A
  • Not specific enough - 1 in 3 men with an abnormal PSA will not have prostate cancer.
  • Not sensitive enough - Up to 20% of men with prostate cancer will not have a raised PSA.
29
Q

What occurs when a patient has both an abnormal PSA and DRE?

A

Refer to urology.

Perform urine test to rule out UTI and repeat PSA within a few weeks.

30
Q

What is the treatment of localised cancer in patients with a life expectancy of greater than 10yrs?

A
  • Active surveilance
  • Radical Prostatectomy +/- hormone ablative therapy.
  • Radical Radiotherapy +/- hormone ablative therapy.
  • Brachytherapy
31
Q

What are the options for treating men with metastic protstate cancer?

A
  • Hormone ablative therapy - the vast majority of men respond.
  • Techniques such as orchidectomy, Anti-androgens, Abiraterone is the latest therapy.
32
Q

What is the management of bony complications in men with hormone refractory prostate cancer?

A

• Biphosphonates - Inhibit the action of osteoclasts and is effective in relieving skeletal pain in 30% of patients.

33
Q
A

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