Testicular Cancer Flashcards Preview

Y3M - Urology > Testicular Cancer > Flashcards

Flashcards in Testicular Cancer Deck (22)
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1

Epidemiology

Most common cancer in males aged 20-40y

Caucasian and Northern European at highest risk

2

Categories

Germ cell tumours (95%) and non-germ cell tumours (NGCTs, 5%)

3

GCT divisions

Seminomas

Non-seminomatous GCTs 

 

Both are usually malignant

4

NGCTs division

Usually benign

Leydig cell tumours (oestrogen)

Sertoli cell tumours (testosterone)

5

Positive thing about seminomas

Tend to remain localised until late and have a very good prognosis

6

NSGCT division

Yolk sac tumours

Choriocarcinomas

Embryonal carcinomas

Teratomas

 

Often metastasise early and have worse prognosis than seminomas

7

Risk factors

Cryptoorchidism 4-10x higher risk of GCTs

Previous testicular malignancy

+ve FH

Kleinfelter's syndrome

8

Clinical features

Unilateral painless testicular lump

Irregular, firm, fixed

Doesnt transilluminate

 

Metastasis might show weight loss, back pain or dyspnoae

9

Lymphatic drainage of the testes

Para-aortic nodes

This means that localised lymphadenopathy may not be present even in metatstaic disease

10

Differentials

Epididymal cyst

Haematoma

Epididymitis

Hydrocoele

11

Investigations

Tumours markers

beta-HCG in 60% of NSGCTs and 15% of seminomas

AFP can be raised in some NSGCTs as well

LDH can also be a marker for tumour volume

12

Imaging

Scrotal ultrasound

Staging by CT chest-abdo-pelvis with contrast

13

When should trans-scrotal percutaneous biopsy be done?

Shouldnt be done

It can cause seeding

14

Staging of testicular cancer

Royal Marsden Classification

15

Explain Royal Marsden

I - Disease confined to testis

II - Infra-diaphragmatic LN involvement

III - Supra and infra-diaphragmatic LN involvement

IV - Extralymphatic metastatic spread

16

General management

Specialist MDT 

Either surgery, radiotherapy or chemo or a combination of them.

17

Treatment of Stage I NSGCTs

Orchidectomy and further management dependent on risk score.

Low risk with no vascular invasion -> Surveillance

High risk -> Adjuvant chemo of cisplatin, etoposide, bleomycin and then surveillance.

18

Treatment of metastatic NSGCTs

Dependent on risk scoring

Cycles of chemotherapy if intermediate

Poor prognosis -> One cycle of chemo before reassessment, might need intensification.

19

Treatment of stage 1 seminomas.

Often with orchidectomy alone and surveillance

If there is a high risk of relapse consider doing chemo.

20

Treatment of metastatic seminoma.

Stage IIA can be treated either with radiotherapy or chemotherapy

Higher stage require primary chemo and treated similar to metastatic NSGCTs

21

What should be done before orchidectomy?

Since sperm abnormalities and Leydic cell dysfunction can ensue you should do a pre-treatment fertility assessment.

Semen analysis

Cryopreservation should be offered as well

22

Complications

Risk of secondary malignancies like leukaemia from radiotherapy and chemo.