Urology - Scrotal swelling or pain Flashcards Preview

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Flashcards in Urology - Scrotal swelling or pain Deck (40)
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Do teratomas and seminomas affect the same age groups?

No. Teratomas tend to affect younger men aged between 20-30 whilst seminomas affect older men over 40.

Think of the mnemonic "troops and soldiers" to remember this.


How are testicular tumours staged?

Stage I: confined to the scrotum
Stage II: spread to retroperitoneal lymph nodes below the diaphragm
Stage III: distant metastases


How do testicular tumours spread?

Germ cell tumours (seminomas and teratomas) metastasise to para-aortic lymph nodes, lung and brain.

In contrast, stroma tumours rarely metastasise.


What are the clinical features of testicular tumours?

Most tumours regardless of the type will present as a painless, hard, swelling of the testes. They are often discovered accidentally or after trauma. Examination reveals a hard, irregular, non tender testicular mass.

Bleeding into the tumour may mimic acute torsion.


What serum markers are associated with testicular tumours?

AFP and HCG are usually normal in seminomas. They are raised in teratomas and yolk sac tumours.

Lactate dehydrogenase is raised in 10-20% of seminomas.


Investigations in testicular cancer?

- Bloods: for tumour markers
- Scrotal ultrasound: diagnosis
- Chest X ray to assess lungs and mediastinum: metastases
- CT scan of chest and abdomen: to detect lymph nodes
- Laparoscopy: to assess abdominal lymph nodes


How are testicular tumours managed?

First line treatment is radical orchidectomy (via groin incision) and histological diagnosis. Further treatment depends on staging and histology.

Stage I: radiotherapy to abdominal lymph nodes (?)
Stage II: radiotherapy to abdominal lymph nodes
Stage III: chemotherapy (bleomycin, etoposide, cisplatin)

Stage I: RPLND - retroperitoneal lymph node dissection
Stage II: chemotherapy + RPLND
Stage III: chemotherapy (+ RPLND if good response)

NB - bleomycin can lead to rare but potentially serious pulmonary toxicity


How is relapsing seminoma or teratoma treated?

Unlike other cancers, patients with relapsed testicular cancer are often cured with second line chemotherapy regimes. The VeIP regime is often used for patients with good prognostic factors, such as low tumour markers, and a complete response to first line therapy:
- vinblastine
- ifosfamide
- mesna
- cisplatin

If a patient has poor prognostic factors then a regime with etoposide and carboplatin is used.


What is the prognosis of testicular cancer?

Overall cure rates are over 90% and node negative disease has almost 100% 5 year survival. Seminomas have a slightly better prognosis than teratomas


What would (i) continually elevated tumour marker levels after orchidectomy and (ii) rising levels during the post operative follow period?

(i) Presence of a metastatic tumour
(ii) Evidence of growth of previously undetected metastases