Testicular Cancer Flashcards
(24 cards)
What kind of tumours are testicular tumours predominantly?
germ cell tumours.
Where do other germ cell tumours commonly arise?
- retroperitoneum
- mediastinum
What is the predominant age bracket for testicular cancer?
how many new cases every year
- 15 to 45 years old
- 2000 cases in the UK
what is the risk factors?
- maldescent of the testes predisposes germ cell tumours
- testicular atrophy
- family history
Describe the aetiology of the tumour
- pre-invasive lesion called an “intratubular germ cell neoplasia”
- when contralateral testis is small it should be biopsied
- treat with radiotherapy as it eventually turns into cancer
1) Describe the histology in 60% of cases
2) Describe the histology of the other 40%
- Non-seminomatous germ cell tumours (NSGC1)
- Seminomas
Note that rare ones include combined (seminoma / non-seminoma), yolk sac tumours,
where is the common spread of seminomas? and how?
- via lymphatics to para-aortic nodes (reflects the embryological origin from para-renal tissue)
- Blood borne spreads to lungs, liver, bone, brain
How might the patient present?
- painless testicular swelling
- in metastasis:
> cough/ dyspnoea due to lung mets
> low- back pain due to para- aortic involvement
What imaging/ bloods?
- testicular ultrasound mandatory (differentiates solid from fluid filled masses)
- beta- HCG and AFP
which marker is raised in both seminomatous and non-seminomatous tumours?
- B-HCG (in 75% of patients)
- AFP only raised in presence of non- seminomatous elements
What other marker can be used and how useful is it?
- Lactate dehydrogenase useful in assessing prognosis, response to treatment and detect relapse
What kind of surgery should be done? and why?
- Orchidectomy done for diagnosis and therapy for localised disease
Why would you do a biopsy of the other testicle? (2)
- cryptorchidism patients
- history of maldescent
(increase risk of bilateral disease)
What kind of imaging should be done?
- CT chest, abdo and pelvis
- usually done post- op
Describe the staging system
Royal Mardsen staging system:
Stage 1- confined to testicle
Stage 2- involves para-aortic lymph nodes below diaphragm
Stage 3- involves para- aortic lymph nodes above diaphragm
Stage 4- involves visceral mets
Why is the royal marsden grouping system not good?
- does not incorporate useful information from tumour markers
- led to formation of prognostic grouping
Describe the IGCCC
- split into seminoma and non- seminoma
- Divided into good, medium and poor prognosis
- incorporating tumour markers, LDH, and the RMG staging system
Describe the nature of germ cell tumours
- highly malignant with rapid growth and high metastatic potential
- generally chemo/ radiosensitive
- The clinical distinction between a seminoma and a tumour with non-seminomatous elements determines management
What is the normal surgical protocol?
- Orchidectomy required for definitive treatment of localised disease
- should be performed via inguinal canal to stop spread through scrotal tissue planes
In metastatic teratoma when is surgery performed?
- surgery performed after chemotherapy for resection of residual mass
- careful examination of edges is performed to see no tumour, removal prevents regrowth
How is adjuvant chemotherapy given?
- Stage 1: carboplatin (seminoma), Non seminoma two cycles of BEP (Bleomycin, etoposide, cisplatin)
some low risk patients for stage 1 do not have chemo - 3-4 cycles of BEP are used in those with more extensive disease
What is BEP?
Bleomycin, etoposide, cisplatin.
It is very intensive and gives expected rates of neutropenia
What is the role of radiotherapy in testicular cancer?
- can be used in conjunction with adjuvant chemotherapy
- for malignant teratoma, radiotherapy to sites of bulky mets used in conjunction with chemotherapy
Describe prognostic factors.
- bulky tumour sites carry a worse prognosis
(the presence of pulmonary mets does not affect prognosis) - presence of yolk sac/ vascular/ lymphatic invasion
- tumour markers (AFP BHCG and LDH associated with poor prognosis)
