Testicular Cancer

Question 1

What is the most common type of testicular cancer?

Answer 1

Germ cell seminoma

Question 2

What are the 3 types of testicular cancer?

Answer 2

1) Germ cell (95%) - seminoma and non-seminoma

2) Non-germ cell (5%)

Question 3

What is the typical age group of testicular cancer?

Answer 3

20-30 years

Question 4

What are risk factors for testicular cancer?

Answer 4

• Undescended testes/crypto-orchidism
• PMH of STI esp. HIV or infertility
• Caucasian
• FH

Question 5

What are the symptoms of testicular cancer?

Answer 5

• Painless testicular mass - maybe discomfort
• Hydrocele (scrotal/testicular swelling)
• Gynaecomastia

Question 6

What is a complication of testicular cancer?

Answer 6

Dyspnoea (lung mets)

Question 7

How do you diagnose testicular cancer?

Answer 7

US - 100% sensitive and assesses blood supply, fluid and size - allows for comparison

Question 8

How do you treat testicular cancer curatively?

Answer 8

• Surgery (orchiectomy)
• Seminoma - adjuvant radiotherapy (external beam radiation)/chemo BEP (carboplatin -bleomycin/cisplatinum/etoposide)
• Non-seminoma - above + retroperitoneal lymph node dissection post-orchiectomy

Question 9

What is a complication of orchidectomy?

Answer 9

Reduced fertility (can freeze sperm before)

Question 10

What might you find on examination of the testes in testicular cancer?

Answer 10

• Asymmetrical testes - one is larger (swollen) and low-lying
• Testicular mass - smooth, non-fluctuating and firmly
  attached (immobile) - not painful

Question 11

What is a type of non-seminoma germ cell tumour?

Answer 11

Choriocarcinoma

Question 12

What are some additional potential symptoms of testicular cancer?

Answer 12

• Lower extremity swelling
• Supraclavicular lymph nodes
• Gynaecomastia
• Lumbar back pain
• Neurological deficits
• Inguinal swelling

Question 13

What blood tests might you do in testicular cancer?

Answer 13

• Serum beta-HCG
• Serum AFP
• Serum LDH

Question 14

What would you find in blood test results in testicular cancer?

Answer 14

• b-HCG > 0.7 elevated in all choriocarcinomas
• AFP > 25 elevated in germ cell
• LDH > 25 elevated in 50% of cases

Question 15

What other investigations might you do after diagnosis of testicular cancer by US?

Answer 15

• CT AP + CXR to assess metastasis and and post-treatment follow-up - staging
• Histology - evaluate histology of mass for
  treatment options + grade

Question 16

What might you see on CXR in testicular cancer (choriocarcinoma)?

Answer 16

Cannonball metastases - urgent referral to oncology (good prognosis, give systemic chemo)

Question 17

How do you treat metastatic testicular cancer?

Answer 17

• 3-4 cycles systemic chemotherapy

- Retroperitoneal lymph node dissection

Question 18

What is the peak age of testicular cancer?

Answer 18

30-34

Question 19

What is an intratesticular mass until proven otherwise?

Answer 19

Testicular cancer

Question 20

What are common complications of testicular cancer?

Answer 20

• Infertility
• Adverse effects of treatment (nausea, neutropenia, kidney injury, pneumonitis/fibrosis)
• Secondary cancer esp. 2nd testicular cancer

Question 21

What is the most common type of cancer in males aged 16-24?

Answer 21

Testicular cancer