Testicular cancer Flashcards
What are the types of testicular cancer?
Seminoma
Non-seminoma- Teratoma, Yolk sac tumour, Embryonal carcinoma
What are the risk factors for testicular cancer?
Undescended testicles
Carcinoma in situ- hasn’t invaded beyond the basement membrane
Family history
Previous testicular cancer- increased risk of 12-18x
Infertility- low semen concentrations, high proportion of abnormal sperm
Hypospadia- condition where urethra opens on the underside of the penis (not this is a CI to circumcision)
Inguinal hernia
More common in white men in the UK
What are the symptoms of testicular cancer?
Main presentation is a lump that is felt on self examination
Lump is not painful
Asymmetry of the testes
Heavy scrotum
Symptoms due to spread
Back pain due to spread to para aortic lymph nodes
Lungs- Cough, Haemoptysis
Mediastinal nodes- Dysphagia, breathlessness
For every cancer
Night Sweats
Weight loss
Fatigue
What are some differentials for a testicular lump?
Varicocele
Hydrocoele
Epididymal cyst
Inguinal hernia
What is the most common type of testicular cancer?
Seminoma
Who does testicular cancer normally present in?
Teratoma and yolk sac tumours usually present in younger males aged 20-30
Seminoma commonly presents around 40 years of age
It is the most common cancer in men aged 20-30
What tumour markers may be raised in testicular cancer?
AFP
Beta- HCG
LDH
Is pain a presenting feature of testicular lumps?
Testicular cancers are often painless
But some are associated with a sharp pain
What investigation should be requested for testicular lumps?
Rapid access testicular ultrasound
What blood tests would you do if suspecting testicular cancer?
LDH
AFP
Beta- HCG
What investigations might be done to investigate someone with a suspected testicular cancer?
Testicular USS
Bloods- AFP, LDH, Beta HCG
CT/MRI- Assess extent of spread and spread to para-aortic nodes
Are biopsies taken for testicular cancer?
No
Generally for a lump that is solid an orchiectomy is carried out. FNAC is not carried out as it could precipitate spread of the cancer outside of the capsule.
Following orchiectomy the mass can be sent for pathological analysis.
What are the treatment options for testicular cancer?
This depends upon the extent of cancer spread
Orchiectomy- No FNAC is done and pathological analysis is done using the specimen after surgery
Chemotherapy- Testicular cancer is highly responsive to chemotherapy
Radiotherapy
Surgical retroperitoneal Lymph Node dissection may be required.
What is it important to coucncil men on before chemotherapy?
Chemotherapy can cause infertility and so sperm banking may be advised. Radiotherapy and orchiectomy also affect fertility.
