Testicular Cancer

Question 1

What is the incidence of testicular cancer?

1 - 3.5 cases per 100,000
2 - 35 cases per 100,000
3 - 350 cases per 100,000
4 - 3500 cases per 100,000

Answer 1

1 - 3.5 cases per 100,000

Question 2

What age does the incidence of testicular cancer peak?

1 - 20-30
2 - 30-40
3 - 40-50
4 - >65

Answer 2

2 - 30-40

Question 3

Which of the following is NOT a risk factor for testicular cancer?

1 - Infertility (increases risk x3)
2 - Age
3 - Cryptorchidism (undescended testicle)
4 - Family history
5 - Klinefelter’s syndrome
6 - Mumps orchitis
7 - Smoking

Answer 3

7 - Smoking

Question 4

All of the following are risk factors for risk factors for testicular cancer, but which is the largest risk factor?

1 - Cryptorchidism (Undescended testes)
2 - Male infertility
3 - Family history
4 - Increased height

Answer 4

1 - Cryptorchidism (Undescended testes)
- the testes fail to descend of get stuck in the inguinal canal

Question 5

Testicular cancer can originate in 3 main places. Which of the following accounts for 95% of testicular cancers?

1 - non-germ cell
2 - germ cell
3 - secondary metastasis

Answer 5

2 - germ cell

Question 6

Which cells do testicular cancer originate from in the testicles?

1 - germ cells
2 - spermatic cord cells
3 - epididymal cells
4 - semen cells

Answer 6

1 - germ cells
- these cells produce gametes
- leydig cells produce testosterone

Question 7

Inside the testicles there are lobules that contain up to 4 seminiferous tubules, which are where sperm is made. What are the cells on the outside of the seminiferous tubules called?

1 - gametes
2 - germ cells
3 - sertoli cells
4 - leydig cells

Answer 7

2 - germ cells
Also called spermatogonia

• spermatogonia divide again and again to form male gametes
• the germ cells are the most common site for testicular cancer formation

Question 8

The germ cells that become testicular cancers can be categorised as a seminoma or non- seminoma. Match the definition of a seminoma and non-seminoma?

1 - cells that divide and differentiate into other types of cells
2 - cells that divide but do not differentiate into other types of cells.

Answer 8

1 - seminoma = cells that divide but do not differentiate into other types of cells.

2 - non-seminoma = cells that divide and differentiate into other types of

Question 9

The germ cells can forma variety of different tumours. Which of the following is the most common?

1 - teratoma
2 - yolk sac tumour
3 - seminoma
4 - choriocarcinoma

Answer 9

3 - seminoma

Question 10

Seminoma germ cells are the most common type of testicular cancer. Which of the following is NOT true about them?

1 - large cells with central nuclei
2 - surrounded by fibrous tissue separates the seminoma from the health ygerm cells
1 - fibrous tissue always contains neutrophils

Answer 10

1 - fibrous tissue always contains neutrophils

The fibrous tissue always contains lymophocytes

Question 11

Seminoma germ cells are the most common type of testicular cancer. What enzymes can be commonly produced by seminomas that can be helpful when trying to diagnose the seminomas?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 11

3 - Placental Alkaline Phosphotase (PLAP)

Typically produced by the placenta

Question 12

There are 3 types of non-seminoma germ cells that become cancerous:

• choriocarcinoma
• yolk sac tumours
• teratoma

Which is these is very aggressive and most common in young children?

Answer 12

• yolk sac tumours

Question 13

Yolk sac tumours are non-seminoma germ cells that have differentiated into yolk sac tissue and are the most commonly found in young children. Under a microscope they form Schiller-Duval bodies, which are rings of malignant cells around the blood vessel. Which of the following do these tumours secrete that can be a useful marker for diagnosis?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 13

1 - Alpha Fetoprotein

Typically secreted by the yolk sac and fetal liver in pregnancy

Resembles albumin in the blood

Question 14

Choriocarcinoma are non-seminoma tumours originating from germ cells. Unlike seminomas these tumours differentiate into 2 types of cells. Which 2 of the following cells do they differentiate into?

1 - leydig cells
2 - sertoli cells
3 - syncytiotrophoblasts
4 - cytotrophoblasts

Answer 14

3 - syncytiotrophoblasts
4 - cytotrophoblasts

Question 15

Choriocarcinoma are non-seminoma tumours originating from germ cells that differentiate into syncytiotrophoblasts and cytotrophoblasts that typically help form the placenta. They are typically small and invade local blood vessels, leading to bleeding. What do the Choriocarcinomas secrete that can be useful when diagnosing these tumours?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin (bHCG)
3 - Placental Alkaline Phosphotase (PLAP)
4 - Lactate dehydrogenase

Answer 15

2 - Beta human chorionic gonadotropin (b-HCG)

• these cells produce HCG during pregnancy and is what is detected in a pregnancy test

Question 16

Which 2 cells do non germ cell testicular cancers come from?

1 - leydig cells
2 - sertoli cells
3 - syncytiotrophoblasts
4 - cytotrophoblasts

Answer 16

1 - leydig cells
2 - sertoli cells

Question 17

Are the non germ cell testicular cancers that originate from sertoli cells dangerous?

Answer 17

• no
• rare, benign and generally do not produce any hormones
• typically located inside the seminiferous tubules

Question 18

Non germ cell testicular cancers that originate from leydig cells originate from outside the seminiferous tubules. They are hormonally active and able to secrete male and female hormones. Excessive testosterone can cause which of the following?

1 - gynaecomastia
2 - premature puberty
3 - feminisation
4 - testicular atrophy

Answer 18

2 - premature puberty

Question 19

Non germ cell testicular cancers that originate from leydig cells originate from outside the seminiferous tubules. They are hormonally active and able to secrete male and female hormones. Excessive estrogen can cause all of the following in adults EXCEPT which one?

1 - gynaecomastia
2 - premature puberty
3 - feminisation
4 - testicular atrophy
5 - erectile dysfunction
6 - reduced libido

Answer 19

2 - premature puberty
- look for Reinke crystals on histology

Question 20

What symptoms are common in patients with testicular cancer?

1 - testicular mass
2 - testicular/abdominal swelling
3 - dull or sharp pain in testicles and abdomen
4 - hydrocele
5 - gynaecomastia
6 - all of the above

Answer 20

6 - all of the above

If it metastases this can spread to the lungs and cause dyspnoea and haemoptysis

Question 21

Which of the following patients should be referred to the two week referral for testicular cancer?

1 - 25 y/o with groin pain and haematruia
2 - 15 y/o with painful enlargement of testicle and change in testicle shape
3 - 30 y/o with inguinal lymph node enlargement

Answer 21

2 - 15 y/o with painful enlargement of testicle and change in testicle shape

Nice referral:

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for testicular cancer in men if they have a non‑painful enlargement or change in shape or texture of the testis.

Question 22

Which of the following hormones is not typically quantified to identify a testicular tumour?

1 - Alpha Fetoprotein
2 - Beta human chorionic gonadotropin
3 - Growth hormone
4 - Lactate dehydrogenase
5 - Placenta alkaline phosphotase (PLAP)

Answer 22

3 - Growth hormone

Alpha Fetoprotein = Yolk Sac Tumours
Beta human chorionic gonadotropin
Lactate dehydrogenase = Choriocarcinoma
Placenta alkaline phosphotase (PLAP) = seminomas

Question 23

What is the 1st imaging modality used in testicular cancer?

1 - MRI
2 - CT KUB
3 - scrotal ultrasound
4 - X-ray

Answer 23

3 - scrotal ultrasound
- staging will be performed using a CT scan

Question 24

If the testicular cancer spreads, which lymph nodes do they spread into?

1 - lumbar lymph nodes
2 - retroperitoneal lymph nodes
3 - inguinal lymph nodes
4 - pelvic lymph nodes

Answer 24

2 - retroperitoneal lymph nodes
- this can lead to lower back pain

Question 25

If the tumour is confined to the testicles, what is typically the treatment of choice?

1 - watch and wait
2 - chemotherapy and adjunct radiotherapy
3 - orchidectomy
4 - brachioradiotherapy

Answer 25

3 - orchidectomy

Chemotherapy and radiotherapy may also be given, depending on the staging.

Question 28

A 27 year old man presents to the GP with 8 month history of increasing R testicular lump and 1 month history of back pain.
o/e there is a 10cm R testicular mass with mild tenderness that does not trans illuminate. What is the 1st line diagnostic tool that should be used here?

1 - multiparametric MRI
2 - cystoscopy
3 - ultrasound
4 - pelvic CT

Answer 28

3 - ultrasound

1st line in suspected testicular cancer

This referral would be on a 2-week referral

Question 29

A 27 year old man presents to the GP with 8 month history of increasing R testicular lump and 1 month history of back pain.
o/e there is a 10cm R testicular mass with mild tenderness that does not trans illuminate. He has some tumour markers assessed:

Alpha Fetal Protein 4200 (0-5)
βhuman chorionic gonadotropin 1300 (<3)
Lactate dehydrogenase 800 (135-225)

Is this more likely to be a seminoma or non-seminoma tumour?

Answer 29

• non-seminoma tumour

BUT as 3 markers are raised, its hard to identify the type of tumour without pathology

Alpha Fetal Protein = yolk sac tumour
βhuman chorionic gonadotropin = Choriocarcinoma
Lactate dehydrogenase = teratoma

Question 30

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?

1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs

Answer 30

2 - granulocyte colony stimulating factors (GCSF)