FN: Testicular Tumours Flashcards Preview

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Flashcards in FN: Testicular Tumours Deck (29):
1

Epi

- Commonest male malignancies from 15-44 yrs
- Whites > blacks =5:1

2

Presentation

1. Painless testicular lump -often noticed after trauma
2. Haematospermia
3. secondary hydrocele
4. Mets: SOB from lung mets
5. Abdomass: para-aortic lymphadenopathy
6. Hormones: gynaecomastia
7. Contralateral tumour in 5%

3

RF

1. Undescended testis -10% occur in undescended testes
2. Infant hernia
3. Infertility

4

Pathology

1. Germ cell
2. Sex-cord Stromal
3. Lymphoma/Leukaemia

5

Germ cell tumour

1. Pure seminomas
2. Non-seminomas (inc.mixed)

6

Sex-cord Stromal

1. Leydig cell
2. Sertoli cell

7

Lymphoma/Leukaemia

1. NHL
2. ALL

8

Pure Seminomas

- Commonest single subtype
- 30-40 yrs
- Raised Beta HCG in 15%
- raised placental ALP in some
- Very radiosensitive

9

Non-seminomas (inc. mixed)

1.Mixed
2. Teratoma
3. Yolk sac
4. Choriocarcinoma

10

Mixed

Commonest NSGCT

11

Teratoma

- Arise from all 3 germ layer
- Common and benign in children
- Rare and malignant in adults: 15-30 yrs
- Secrete beta HCG and/or AFP
- chemosensitive

12

Yolk sac

Commonest testicular tumour in children

13

Choriocarcinoma

Very high beta HCG

14

Leydig cell

Mostly benign
May secrete androgens or oestrogens

15

Sertoli cell

- mostly benign
- May secrete oestrogens

16

NHL

Commonest malignant testicular mass >60 yrs

17

ALL

Commonest malignant testicular mass

18

Staging: Royal Marsden Classification

1. Disease only in testis
2. Para-aortic ndes involved (below diaphragm)
3. Supra- and infra- diaphragmatic LNs involved
4. Extra-lymphatic spread: lungs, liver

19

Investigations

1. Tumour marker
2. Scrotum US
3. Staging

20

Tumour markers

1. Useful for monitoring
2. Raised AFP anf hCG in 90% of teratomas
3. Raised hCG in seminomas
4. Normal AFP in pure seminomas

21

Staging done with

CXR
CT

22

NEVER

Percutaneous biopsy should not be performed as it may - seeding along needle tract

23

Management

If both testes are abnormal, semen can be cryopreserved

24

Seminomas Mx stage 1-2

Inguinal orchidectomy + radiotherapy
- groin incision allows cord clamping to prevent seeding

25

Seminomas Mx stage 3-4

Inguinal orchidectomy + radiotherapy
- groin incision allows cord clamping to prevent seeding

With Chemo )BEP_

26

Chemo used in seminomas

Bleomycin
Etoposide
CisPlatin

27

Non-seminomas/Teratomas Mx

stage 1: Inguinal orchidectomy + surveillance
Stage 2: Orchidectomy + chemo + para-aortic LN dissection
Stage 3: Orchidectomy + chemo

28

Close/f/up to detect relapse

- Typically w/i 18-24mo
- Repeat CT scanning and tumour markers

29

Prognosis

- Stage 1: 98% 5yrs
Stage 2: 85% 5yrs
Stage 3: 60% 5 yrs

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