Testicular Cancer Flashcards
Types of testicular cancer
Germ cell:
- Seminoma
- Teratomas
- Embryonal carcinoma
- yolk sac tumour
- Trophoblastic tumours
- Mixed germ cells
Sex cord-stromal:
- Leydig cell
- Sertoli cell
- Granulosa cells
Features of seminomas
Most common (40-50%)
Malignant
Slow growth and late mets
Marker: placental alkaline phosphatase (PLAP)
Features of embryonal tumours
Derived from germ cells that will develop into embryonic pluripotent stem cells
Small and painful
Aggressive
Features of teratomas
Can contain any type of tissue e.g. skin, hair, nails, bone, teeth, muscle
Mature cystic teratoma
- Cyst with fully developed tissue
- Usually appears in children (benign)
- Often malignant in adults
Immature Teratoma
- Undifferentiated tissue that resembles embryonic tissues
- Usually in adults
- Usually malignant and metastasises quickly
Features of choriocarcinoma
Derived from germ cells that will produce syncytiotrophoblasts and cytotrophoblasts
Small but malignant (most aggressive)
Rapid growth which results in ischaemia and necrosis from inadequate blood supply
Marker: hCG
Features of yolk sac tumours
Most common tumour in children
Aggressive, with high malignant potential
Marker: alpha fetoprotein
Features of Leydig cell tumours
Hormonally active
Testosterone → Premature puberty (young males): Prominent external genitalia, pubic hair growth, accelerated skeletal and muscle development, and mature masculine voice, precocious puberty
Oestrogen → Feminisation, delayed puberty (Young), Gynaecomastia, feminine hair distribution, erectile dysfunction, testicular atrophy, loss of libido
Features of sertoli cell tumours
Small and usually benign
Don’t usually produce any hormones
Features of testicular lymphoma
Most common testicular tumour in men >60
Usually extranodal non-Hodgkin lymphoma
Risk factors for testicular cancer
Cryptorchidism (undescended testis)
Gonadal dysgenesis
Family history or personal history
Testicular atrophy
White ethnicity
HIV
Chemical carcinogens and low sperm count, rural residence, higher socioeconomic status, inguinal hernia, genetic abnormality
Symptoms and signs of testicular cancer
Testicular mass
- 55% on the right, 2% bilateral
- Usually painless (>85%)
- Smooth, painless, hard
- does NOT transilluminate
Acute painful swelling (10%)
Non-specific, dull testicular discomfort
Extra-testicular:
Bone pain (skeletal mets)
Lower extremity swelling (venous occlusion)
Lumbar back pain (psoas and nerve root involvement)
Massive pleural effusion
Lymphadenopathy
Signs of hyperthyroidism
Investigations for testicular cancer
2WW
Tumour markers: b-hCG, AFP, LDH, placental alk phos, seurm gamma-GT
Baseline: FBC, U&Es, G&S, clotting
US with colour doppler: characterise testicular mass
- Seminoma = hypoechoic mass, vascularised
CT CAP: staging, node status
CXR: ?mets
Orchiectomy → histological exam
Management for testicular cancer
2WW urology
- Radical inguinal orchidectomy (testicle, spermatic cord, appendages) - day procedure
- wishing to preserve gonads, mass <2mm → testis sparing surgery through inguinal incision - Confirmation via histology
- Repeat tumour markers
Early stage seminoma → External beam radiotherapy OR chemo (carboplatin)
Early stage non-seminoma → Retroperitoneal lymph node dissection (RPLND) + chemotherapy
Advanced cancer → Combination chemotherapy post-orchiectomy BEP (Bleomycin, etoposide, cisplatin)
Complications of treatment for testicular cancer
Surgery
- Reduced fertility OR infertility (minimal if other testicle preserved)
- Post-operative haemorrhage
Chemotherapy with cisplatin
- Nausea and vomiting → IV anti-emetics + home anti-emetics (dexamethasone, eprepitant, 5-HT3 antagonists)
- Infertility
- Neutropenia
- AKI
- Treatment-related secondary cancer
Chemotherapy with bleomycin
- Pulmonary toxicity (pneumonitis, fibrosis)
Radiotherapy
- Infertility
- Treatment-related secondary cancer
Prognosis for testicular cancer
With appropriate treatment, the vast majority of seminoma or non-seminoma cases will be cured.
If relapse occurs, there is still an opportunity for cure from chemotherapy.
Mets is usually to retroperitoneal lymph nodes
Mets: combination chemo has a good chance at eradication
