Testicular Cancer

Question 1

What are the risk factors of testicular cancer?

Answer 1

Cryptorchidism (hidden testis)
- undescended/ascendant tested, atrophic as a result?

Family Hx

Caucasians

Infertility

Past infection esp. Mumps

Intersex state

Question 2

What are the types of testicular cancer?

Answer 2

Germ cell tumours (~95%)
- arise from germ cells (gamete precursors)
> Non-seminomas (~50%) including teratomas
> Seminomas (~45%)

Non Germ cell tumours (~5%)
- may arise from connective tissue, other cells, or as secondaries elsewhere

Question 3

What are the symptoms of testicular cancer?

Answer 3

Lump (97%) - usually asymptomatic - often less tender than normal testis

Pain (31%)

Heaviness/Dragging (30%)

Metastases and associates symptoms
- lymph drains to deep retroperitoneal nodes therefore rarely palpable unless huge

Gynaecomastia (5%) - development of female breast tissue

Question 4

What investigations would be done for suspected testicular cancer?

Answer 4

USS - very reliable

Tumour markers

• alpha-feta protein (alpha-FP)
• beta-human chorionic gonadotrophin (beta-HCG)
• Lactate Dehydrogenase (LDH)

MRI/CT abdo - for staging purposes, i.e. lymph nodes, mets

Question 5

Where is alpha-FP produced, and when is it sometimes raised?

Answer 5

Embryonal protein produced by yolk sac and liver

Raised in most non-seminoma Germ Cell Tumours
May also be raised in liver cancer

Question 6

What is beta-hCG and when is it raised?

Answer 6

Product of placental trophoblastic tissue

Raised in:

• most non-seminoma germ cell tumours
• some seminoma germ cell tumours

Also raised in bronchial/UGIT/bladder cancers

Question 7

What is LDH and when is it raised?

Answer 7

Produced in conversion of pyruvateflactate

Raised in some seminoma germ cell tumours
Also raised if increased anaerobic glycolysis

Question 8

How should testicular cancer be treated?

Answer 8

Surgery - inguinal orchidectomy

• remove testis and spermatic cord
• offer contralateral testis removal if atrophies, cryporchid or <30y/o

Radiotherapy - early stage seminoma

Chemotherapy - non-seminomas and late stage seminomas

Surveillance

Question 9

Prognosis of testicular cancer?

Answer 9

Very good - very low mortality even in metastatic disease since very responsive to radio/chemotherapy