TESTICULAR TUMOURS

Question 1

Mass in SCROTUM
🚦DIFFERENTIAL DIAGNOSIS🚦

🧠⚡SHOVE IT⚡

Answer 1

SHOVE IT:
1. Spermatocele
2. Hydrocele
3. Haematocele
4. Orchitis
5. Varicocele
6. Epidymal cyst
7. Indirect inguinal hernia
8. Torsion/ Tumor

Question 2

Classification of TESTICULAR TUMOUR
🧠⚡ Non-seminomatous: CETY⚡

Answer 2

Question 3

⚡⚡ MOST COMMON TESTICULAR TUMOUR

⚡⚡ MOST COMMON TESTICULAR TUMOUR IN CHILDREN

⚡⚡ MOST COMMON TESTICULAR TUMOUR IN ELDERLY

Answer 3

⚡⚡ MOST COMMON TESTICULAR TUMOUR
🎯 SEMINOMATOUS

⚡⚡ MOST COMMON TESTICULAR TUMOUR IN CHILDREN
🎯 YOLK SAC TUMOURS

⚡⚡ MOST COMMON TESTICULAR TUMOUR IN ELDERLY
🎯 LYMPHOMA

Question 4

⚡⚡ MOST COMMON B/L TESTICULAR TUMOUR

Answer 4

Lymphoma

Question 5

⚡⚡ MOST COMMON PRESENTATION OF TESTICULAR TUMOUR

Answer 5

Painless TESTICULAR Mass

Others:
✨ Abdominal Lump: Retroperitoneal Lymph node

✨ Cannon Ball Metastasis to Lung

Question 6

HURRICANE TUMOUR

Answer 6

✨ Very aggressive CHORIOCARCINOMA
✨ 6 months: SURVIVAL TIME
✨ Exceeds its own blood supply
🎯 Testis Shrinks &
🎯 Metastasis to other organs

Question 7

Sertoli cell tumour presents as
🧠⚡S for S⚡

Leydig cell tumour presents as
🧠⚡L⚡

Answer 7

🎯 Sertoli cell tumour presents as SILENT tumour ➡️ releases INHIBIN

🎯 LEYDIG cell tumour presents as
✨ Gyanecomastia
Estrogen & Androgen secreting

Question 8

⭐ Maximum Alpha Fetoprotein is secreted by which TESTICULAR TUMOUR

⭐ ⭐ Maximum Beta HCG is secreted by which TESTICULAR TUMOUR

🧠⚡ In anticlockwise
AD
BC ⚡

Answer 8

Question 9

FNAC (OR) TRANS-SCROTAL Biopsy is NOT DONE is SUSPECTED TESTICULAR TUMOUR?

Answer 9

DUE TO RISK OF UPSTAGING the Stage

Question 10

CHEVASSU MANEUVER done in

Answer 10

Suspected TESTICULAR TUMOUR
⬇️
HIGH INGUINAL INCISION

Question 11

WORK UP IN A SUSPECTED TESTICULAR TUMOUR

Answer 11

Question 12

Usually TNM Staging is done for most tumours, TNMS staging is done for

Answer 12

TESTICULAR TUMOUR
S = Value of Tumour Markers (Post Orchidectomy Values)

Question 13

1st DRAINING LYMPH NODE for TESTICULAR TUMOUR

Answer 13

Para-aortic Lymph node

Question 14

🩺 IOC for STAGING of TESTICULAR CANCER

Answer 14

PET-CT

Question 15

T STAGING of TESTICULAR TUMOUR

Answer 15

T1: Limited to TESTIS & EPIDIDYMIS ± Involvement of TUNICA ALBUGINA
✨ T1a: < 3cm
✨ T1b: > 3cm

T2: Limited to TESTIS & EPIDIDYMIS ± Involvement of TUNICA ALBUGINA ➕ TUNICA VAGINALIS ➕ Vascular/lymphatic Invasion

T3: Spermatic CORD Involvement ± Vascular/lymphatic Invasion

T4: Invades SCROTUM ± Vascular/lymphatic Invasion

Question 16

N STAGING of TESTICULAR TUMOUR

Answer 16

N0 : No Regional LN Metastasis
N1: ≤ 5 LN size ≤ 2cm
N2: > 5 LN size > 2cm & < 5cm
N3: Size > 5cm

Question 17

M STAGING of TESTICULAR TUMOUR

Answer 17

M0: No distant Metastasis
M1A: Lung (OR) Non-regional Lymph nodes
M1B: Metastasis elsewhere

Question 18

T½ of
⭐ Beta HCG
⭐ AFP

Answer 18

⭐ Beta HCG
🎯 1-3 days

⭐ AFP
🎯 5-7 days

Question 19

AFP is NEVER RAISED in

Answer 19

Pure SEMINOMA

Question 20

Tumour Markers for SEMINOMA

🧠⚡TONKI ⚡

Answer 20

1. Twelve p Isochromosome (12p)
2. OCT3/4
3. Nanog
4. c-KIT

Question 21

ITGCN Can give rise to all TESTICULAR Tumours EXCEPT
🧠⚡STP ⚡

Answer 21

1. Spermatocytic SEMINOMA
2. Teratoma
3. Pre-pubertal Yolk Sac Tumour

Question 22

Difference BETWEEN SEMINOMATOUS & NON-SEMINIMATOUS GCT

Answer 22

Question 23

💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT
⭐ STAGE 1

Answer 23

Chemotherapy: BEP

Question 24

💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT
⭐ STAGE 2

Answer 24

Induction CHEMOTHERAPY
⬇️ if LN ➕ & TUMOUR markers ➕
⬇️
RETROPERITONEAL LYMPH NODE DISSECTION

Question 25

💊💉 MANAGEMENT of NON-SEMINIMATOUS GCT ⭐ STAGE 3

Answer 25

Chemotherapy ⬇️ if LN ➕ & TUMOUR markers ➕ 2nd LINE CHEMO ⬇️ if LN ➕ & TUMOUR markers ➕ Salvage RPLND

Question 26

💊💉 MANAGEMENT of STAGE 1 SEMINOMATOUS GCT ⭐ with GOOD PROGNOSTIC FACTORS ⭐ with BAD PROGNOSTIC FACTORS

Answer 26

⭐ with GOOD PROGNOSTIC FACTORS 🎯 SURVILLANCE ⭐ with BAD PROGNOSTIC FACTORS 🎯 Single Cycle of PLATINUM based CHEMOTHERAPY

Question 27

💊💉 MANAGEMENT of STAGE 2 SEMINOMATOUS GCT 🧠⚡Stage 2 = TESTIS ➕ LN belows diaphragm⚡

Answer 27

⭐ RADIOTHERAPY (30 Gy) to PARA-AORTIC LN ✨ Inverted Y Fashion ⬇️ ⬇️ (residual LN ➕) Chemotherapy

Question 28

💊💉 MANAGEMENT of STAGE 3 SEMINOMATOUS GCT 🧠⚡Stage 3 = TESTIS ➕ LN above diaphragm (METASTASIS)⚡

Answer 28

Chemotherapy (BEP) ⬇️ followed by Radiotherapy

Question 29

BEP Regimen

Answer 29

Bleomycin Etoposide cisPlatin

Question 30

Lymph node dissection is VERY DIFFICULT in SEMINOMA Why?

Answer 30

Adherent to VESSELS

Question 31

In RETROPERITONEAL LYMPH NODE DISSECTION, Always NERVE SPARING Technique must be done Why?

Answer 31

To MAINTAIN ANTEROGRADE EJACULATION

Question 32

Role of METASTATECTOMY in TESTICULAR TUMOUR

Answer 32

Survival ⬆️ ⬆️ on removal of Mets