Urethra, Penis And Scrotum Part 2

Question 1

What are the 3 risk factors for tumour of the testis ? (3)

Answer 1

1. Undescended testis
2. Infant hernia
3. Infertility

Question 2

Germ cell tumours make up 95% of all scrotal tumours, describe the 2 types

Answer 2

Pure Seminomas (80%)
- age group >30
Non- seminomas germ cell tumours :NSGCT
- mixed NSGCT
- Teratomas (rare in adults: 15-30)
- yolk sac tumours (commonest amongst children)
- choriocarcinoma

Question 3

Apart from germ cell tumours what are the 3 other types of tumours ?

Answer 3

1. Sex cord strongly tumours
2. Leydig cells
3. Lymphoma/leukaemia

Question 4

Describe the 3 main symptoms of a testicular tumour

Answer 4

1. Painless testicular lump with/without abdominal swelling
2. Symptoms due to Mets
3. Haemospermia/Hydrocele may be present

Question 5

What is a rare symptom of testicular tumours ?

Answer 5

Gynaecomastia

Question 6

What are the 3 investigations used for testicular tumours ?

Answer 6

1. USS of scrotum
2. Tumour markers:
   - Teratomas: AFP and b-hcg
   - seminomas: b-hcg and placental ALP
3. CT CAP for staging

Question 7

What is the management of seminomas according to stage ?

Answer 7

Stage 1-2: inguinal orchidectomy + radiotherapy

Stage 3-4: as above + chemo

Question 8

What is the management of Teratomas according to stage ?

Answer 8

Stage 1: inguinal orchidectomy + surveillance
Stage 2: orchidectomy + chemo
Stage 3: above + para-aortic lymph nodes removed