Testicular Cancer

Question 1

What are the main types of testicualar cancer?

Answer 1

95% - Germ Cell Tumour (GCT)
Either Seminomatous GCT (30s/40s) or Non-seminomatous GCT (aka teratoma, 20s/30s)

5% are Non-GCT

Question 2

How does testicular cancer present?

Answer 2

Usually just a painless lump, may have:

• Tender inflammated swelling
• Trauma history
• Metastatic symptoms (chest/bone/para-aortic lymph nodes)

Question 3

DDX for testicular lumps?

Answer 3

1) Cancer
2) Infection (Epididymo-orchitis)
3) Epididymal Cyst
4) Missed Testicular Torsion

Question 4

Risk factors for testicular cancer?

Answer 4

3rd decade (much younger than most cancers)
Caucasian
Infertility
Testicular maldescent
Atrophic Testis
H/O Testicular Cancer

Question 5

What tests can be done for Testicular Cancer?

Answer 5

MSSU
Testicular US/XR
Tumour Markers

Question 6

What tumour markers do you look for and what type of cancer do they indicate?

Answer 6

• Alpha-fetoprotein (AFP) - Teratoma
• BetaHCG (Human chorionic Gonadotrophin) - Seminoma
• LDH (Lactate Dehydrogenase)) - Non-specific tumour marker

Question 7

How do we treat testicular cancer?

Answer 7

Radical Orchidectomy (may need biopsy of contralateral testis to check for cancer)

Secondary Treatment depends on stage:

• low stage -ve markers - Surveillance, maybe RT/chemo
• Nodal/relapse/persistant markers - Chemo or Lymph node Dissection
• Metastases require chemo

Question 8

Prognosis for testicular cancer?

Answer 8

Very good
Stage 1 - 99% 5 yr survival
Stage 4 - 73% 5 yr survival

Question 9

How do we grade/stage testicular cancer?

Answer 9

Grade - Assesses agggression based on differentiation

Staging - Assesses spread based on pathology exam of testi, CTs

Question 10

4 Stages of Testicular Cancer?

Answer 10

1) Testis Disease
2) Infradiagphragmatic nodes
3) Supradiaphragmatic Nodes
4) Extralymphatic Disease