What are the main types of testicualar cancer?
95% - Germ Cell Tumour (GCT)
Either Seminomatous GCT (30s/40s) or Non-seminomatous GCT (aka teratoma, 20s/30s)
5% are Non-GCT
How does testicular cancer present?
Usually just a painless lump, may have:
- Tender inflammated swelling
- Trauma history
- Metastatic symptoms (chest/bone/para-aortic lymph nodes)
DDX for testicular lumps?
2) Infection (Epididymo-orchitis)
3) Epididymal Cyst
4) Missed Testicular Torsion
Risk factors for testicular cancer?
3rd decade (much younger than most cancers) Caucasian Infertility Testicular maldescent Atrophic Testis H/O Testicular Cancer
What tests can be done for Testicular Cancer?
What tumour markers do you look for and what type of cancer do they indicate?
- Alpha-fetoprotein (AFP) - Teratoma
- BetaHCG (Human chorionic Gonadotrophin) - Seminoma
- LDH (Lactate Dehydrogenase)) - Non-specific tumour marker
How do we treat testicular cancer?
Radical Orchidectomy (may need biopsy of contralateral testis to check for cancer)
Secondary Treatment depends on stage:
- low stage -ve markers - Surveillance, maybe RT/chemo
- Nodal/relapse/persistant markers - Chemo or Lymph node Dissection
- Metastases require chemo
Prognosis for testicular cancer?
Stage 1 - 99% 5 yr survival
Stage 4 - 73% 5 yr survival
How do we grade/stage testicular cancer?
Grade - Assesses agggression based on differentiation
Staging - Assesses spread based on pathology exam of testi, CTs
4 Stages of Testicular Cancer?
1) Testis Disease
2) Infradiagphragmatic nodes
3) Supradiaphragmatic Nodes
4) Extralymphatic Disease