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X - Cancer Care COPY > Testicular Tumours > Flashcards

Testicular Tumours Flashcards

1
Q

What is the importance of testicular tumours?

A

Most common male malignant from 15-44 years

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2
Q

What is the ratio of white:black in testicular tumour?

A

5:1

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3
Q

How do testicular tumours present?

A

Painless testicular lump
Haematospermia
Symptoms of mets or lymph node involvement
Hormonal symptoms

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4
Q

What presentation may occur secondary to a testicular tumour?

A

Hydrocele

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5
Q

What symptoms of mets might be present with testicular tumours?

A

SOB from lung mets

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6
Q

What symptoms of lymph node involvement may be present with testicular tumours?

A

Abdominal mass from para-aortic lymphadenopathy

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7
Q

What hormonal symptoms may be present in testicular tumours?

A

Gynaecomastia

Virilisation

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8
Q

What % of patients with testicular tumours have a contralateral tumour?

A

5%

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9
Q

What are the risk factors for testicular tumours?

A

Undescended testis
Infant hernia
Infertility

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10
Q

What % of testicular tumours occur in those with undescended testis?

A

10%

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11
Q

What are the types of testicular tumours?

A

Germ cell tumours
Non-seminomas
Sex-cord stromal
Lymphoma/leukaemia

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12
Q

What % of testicular tumours are germ cell tumours?

A

95%

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13
Q

What are the types of germ cell testicular tumours?

A

Pure seminomas

Non-seminomas

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14
Q

What % of germ cell testicular tumours are pure seminomas?

A

40%

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15
Q

What age do pure seminoma germ cell testicular tumours present?

A

30-40

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16
Q

What tumour markers may be raised in pure seminoma germ cell testicular tumours?

A

Incrased ßhCG in 15%

Increased placental ALP in some

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17
Q

What is true of pure seminoma germ cell testicular tumours, regarding treatment?

A

They are very radiosensitive

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18
Q

What are the types of non-seminoma germ cell testicular tumours?

A

Mixed
Teratoma
Yolk sac
Choriocarcinoma

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19
Q

Where do testicular teratomas arise from?

A

All 3 germ cell layers

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20
Q

How are testicular teratomas different depending on when they present?

A

They are common and benign in children, but rare and malignant in adults

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21
Q

What tumour markers do testicular teratomas secrete?

A

ßhCG and/or AFP

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22
Q

What is true of testicular teratomas, regarding treatment?

A

Chemosensitive

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23
Q

What is the most common testicular tumour in children?

A

Yolk sac tumour

24
Q

What tumour marker is greatly increased in testicular choriocarcinoma?

A

ßhCG

25
Q

What are the types of sex-cord stromal testicular tumours?

A

Leydig cells

Sertoli cells

26
Q

What is true of the prognosis of Leydig cell tumours?

A

They are mostly benign

27
Q

What might Leydig cell tumours secrete?

A

Androgens or oestrogens

28
Q

What is true of the prognosis of Sertoli cell tumours?

A

They are mostly benign

29
Q

What may Sertoli cell tumours secrete?

A

Oestrogens

30
Q

What is the most common malignant testicular mass >60 years?

A

Non-hodgkins lymphoma

31
Q

What is the most common malignant testicular mass <5 years?

A

Acute lymphoblastic leukaemia

32
Q

What is used for staging of testicular tumours?

A

Royal Marsden Classification

33
Q

What are the features of a stage 1 testicular tumour?

A

Disease only in the testis

34
Q

What are the features of a stage 2 testicular tumour?

A

Para-aortic nodes involved (below diaphragm)

35
Q

What are the features of a stage 3 testicular tumour?

A

Supra- and intra-diaphragmatic nodes involved

36
Q

What are the features of stage 4 testicular tumour?

A

Extra-lymphatic spread to lungs and liver

37
Q

What investigations are done in testicular tumours?

A

Tumour markers
Scrotum US
Staging

38
Q

What are tumour markers useful for in testicular tumours?

A

Monitoring

39
Q

What tumour markers may be raised in teratomas?

A

AFP and ßhCG

40
Q

What % of teratomas have raised AFP and ßhCG?

A

90%

41
Q

What % of seminomas have raised hCG?

A

15%

42
Q

What investigations are used for staging in testicular tumours?

A

CXR

CT

43
Q

Why should percutaneous biopsy not be performed in testicular tumours?

A

May get seeding along needle tract

44
Q

What can be done if both testes are abnormal, in order to allow patient to have kids?

A

Semen can be cryopreserved

45
Q

How are stage 1-2 seminomas managed?

A

Inguinal orchidectomy and radiotherapy

46
Q

How is seeding prevented during inguinal orchidectomy for seminoma?

A

Groin incision allows cord clamping to prevent seeding

47
Q

How are stage 3-4 seminomas managed?

A

Inguinal orchidectomy, radiotherapy, and chemotherapy

48
Q

What chemotherapy regime is used in stage 3-4 seminoma?

A

Bleomycin
Etoposide
Cisplain

49
Q

How are stage 1 non-seminomas/teratomas managed?

A

Inguinal orchidectomy and surveillance

50
Q

How are stage 2 non-seminomas/teratomas managed?

A

Orchidectomy + chemo + para-aortic lymph node dissection

51
Q

How are stage 3 non-seminomas/teratomas managed?

A

Orchidectomy and chemo

52
Q

What is involved in surveillance to detect relapse in testicular tumours?

A

Repeat CT scanning and tumour markers, typically within 18-24 months

53
Q

What is the prognosis of a stage 1 testicular tumour?

A

98% at 5 years

54
Q

What is the prognosis of a stage 2 testicular tumour?

A

85% at 5 years

55
Q

What is the prognosis of a stage 3 testicular tumour?

A

60% at 5 years

X - Cancer Care COPY (36 decks)

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