Urological Malignancies Flashcards
How common is testicular cancer?
- uncommon (not in top 20 most common cancers in men overall)
- however, in male 15-49yo age group, it is the most common type of cancer
- it is also highly responsive to treatment
- therefore, important to recognise + diagnose
How do testicular tumours usually present?
- as painless lump
- NICE recommend any patient w/ swelling or mass in body of testis should be referred urgently (2 week suspected cancer referral pathway) to a urologist for investigation
What is the work-up by the urologist for suspected testicular cancer?
- ultrasound of testicles
- serum tumour markers
What are the majority of testicular cancers?
- >90% germ cell tumours (GCTs)
- germ cell tumours are so called bc they are derived from germ cells of testis which normally develop into mature spermatozoa
There are many types of germ cell tumours, they are divided into two groups. What are these two groups?
Seminoma and non-seminomatous GCTs
For T year, we only expect you to know about seminoma. You are not expected to know about the subtypes of NSGCTs but you should be aware of the existence of the NSGCT group of tumours.
Why is the classification of germ cell tumours useful?
- prognosis - NSGCTs generally behave more aggressively than seminoma
- management - bc of their aggressiveness, NSGCTs often require chemotherapy in addition to radical orchidectomy. Seminoma is usually managed w/ radical orchidectomy alone as is less likely to require chemotherapy
Seminoma has a peak incidence in the 30-40yr age group. Where does it arise?
- type of germ cell tumour
- arises in the seminiferous tubules of testis
- remember that the seminiferous tubules are site of spermatogenesis:
- germ cell -> spermatogonia -> spermatocyte -> spermatid -> spermatozoa
What is the primary treatment for seminoma?
- radical orchidectomy
- seminoma usually spreads via lymphatics to para-aortic retroperitoneal lymph nodes; chemo to treat involved retroperitoneal nodes may be employed (if required)
What is meant by ‘pure seminoma’?
- pure seminoma = seminoma without other germ cell components is classified as seminoma
- however, a tumour containing seminoma mixed with one or more germ cell components listed in the table (prev) above is classified as a ‘non-seminomatous germ cell tumour’. At first glance, this may seem confusing but it makes sense bc the non-seminomatous component behaves more aggressively + so its presence trumps the seminomatous component for the purposes of prognosis/management + so determines the classification
What comparisons can be made between seminomas and non-seminomatous germ cell tumours?
- testicular germ cell tumours are uniquely chemo- and radiosensitive
- consequently, cure rates for these tumours are more than 80% even in those w/ metastases
- however, treatment can be less intensive when disease is diagnosed at an earlier stage
Compare and contrast the features of the most common ovarian and testicular tumours
Measuring certain tumour markers is part of the work up of testicular masses. They ar euseful for initial assessment, monitoring response to therapy and in the long-term follow-up for recurrence.
What does alpha-fetoprotein (AFP) indicate?
- marked elevation of serum AFP is typical of yolk sac tumours
- not elevated in pure seminoma
What does human chorionic gonadotrophin (HCG) indicate?
- HCG normally synthesised by syncitiotrophoblast cells of placenta
- choriocarcinomas often produce high levels of HCG
- not usually elevated in pure seminomas (but may be)
What does high levels of lactate dehydrogenase (LDH) indicate?
- degree of LDH elevation corresponds well w/ bulk of tumour
- therefore useful in assessing tumour burden
