Testicular Mass

Question 1

Conditions causing painless scrotal swelling are not true emergencies, Unless….

Answer 1

testicular tumors are discovered which are life threatening and require urgent evaluation

Question 2

Testicular cancer is most common neoplasm in men aged

Answer 2

20-35

Question 3

_____ is necessary for diagnosis

Answer 3

Orchiectomy

Question 4

Approximately 5% of testicular cancer develop in patients with a history of what?

Answer 4

cryptorchism

Question 5

Signs and symptoms of what issue?
(a) Painless enlargement of the testis
—-Patient is usually first to recognize abnormality but delay in seeking medical attention 3-6 months
(b) Sensations of heaviness
(c) Acute testicular pain because of intra- testicular hemorrhage occurs in about 10% of patients
(d) 10% are asymptomatic at presentation
(e) 10% manifest symptoms relating to metastatic disease at presentation
—-Back pain - retroperitoneal metastases
—-Cough - pulmonary metastases
—-Lower extremity edema - vena cava obstruction
(f) Gynecomastia is seen in 5% of patients

Answer 5

Testicular Cancer

Question 6

DDx for testicular cancer

Answer 6

(a) Hydrocele
(b) Epididymo-orchitis
(c) Lymphoma of testis
(d) Metastases to the testis
(e) Epidermoid cyst
(f) An incorrect diagnosis is made at the initial examination in up to 25% of patients with testicular tumors

Question 7

An incorrect diagnosis is made at the initial examination in up to what percentage of patients with testicular tumors?

Answer 7

25%

Question 8

True/False
Testicular Tumor
Patient is usually first to recognize abnormality but delay in seeking medical attention 3-6 months

Answer 8

True

Question 9

If you suspect a patient has a testicular tumor, what tests can you run?

Answer 9

**Urine hCG (pregnancy test). If it is positive you should have a high suspicion for cancer.
(1 Alpha-fetoprotein
(2 Lactate dehydrogenase
(3 Liver function tests
(a Elevated in hepatic metastases
(4 CBC - Anemia may be present in advanced disease

Question 10

Imaging for Testicular Tumor

Answer 10

(a) Scrotal ultrasound - Determine if mass is intra-testicular or extra-testicular
(b) Clinical staging (once diagnosis is made)
— Chest, abdominal, and pelvic CT scanning

Question 11

Testicular cancers with retroperitoneal disease are treated with what?

Answer 11

radical orchiectomy and retroperitoneal irradiation

Question 12

More advanced cancers require what?

Answer 12

chemotherapy

Question 13

5-year disease free survival for patients with stage I-III are between what percentages depending on staging.

Answer 13

90-100%

Question 14

Patients with disseminated disease have a 5-year disease free survival rate of what?

Answer 14

55- 80%

Question 15

Follow up
(a) Refer all patients with solid masses of the testis to a ______
(b) TO _______ if metastatic disease is suspected is suspected.

Answer 15

a) Urologist
b) Oncology
-.

Question 16

Acute testicular pain because of _______ occurs in about 10% of patients

Answer 16

intra- testicular hemorrhage

Question 17

Up to 75% of Testicular tumor cases are cured by what?

Answer 17

inguinal orchiectomy