Germ Cell Tumours

Question 1

dont do this deck Are germ cell tumours common?

Answer 1

No, they are rare

Question 2

What % of testicular tumours are germ cell tumours?

Answer 2

95%

Question 3

What % of ovarian malignancies are germ cell tumours?

Answer 3

3-5%

Question 4

When are germ cell tumours the most common cancer?

Answer 4

In men aged 20-40

Question 5

When is the peak incidence of ovarian GCT?

Answer 5

Young women and adolescent girls

Question 6

What % of GCT do extra-gonadal tumours account for?

Answer 6

Less than 10%

Question 7

Where do extra-gonadal GCT occur?

Answer 7

In midline structures, most commonly in mediastinum and retroperitoneum, and rarely the brain, head, and neck

Question 8

When is the peak incidence of GCT in the mediastinum?

Answer 8

3rd decade of life

Question 9

What is the strongest risk factor for testicular GCTs?

Answer 9

Family history of testicular cancer

Question 10

What are the other risk factors for testicular GCT?

Answer 10

• History of maldescent
• History of torsion
• Kleinfelter’s syndrome
• Atrophic testis
• Previous testicular cancer
• Infertility
• In utero exposure to oestrogens

Question 11

What genetic abnormality is found in more than 80% of testicular cancers?

Answer 11

12p gain, often as an isochromosome of 12p, where one arm of the chromosome is lost and replaced with an exact replica of the other arm

Question 12

What is the precursor to testicular GCT?

Answer 12

Carcinoma in situ

Question 13

What % of malignant GCT in men are seminomas?

Answer 13

50%

Question 14

When is the peak incidence of seminomas?

Answer 14

30-40

Question 15

When is spermatic seminoma more common?

Answer 15

Older men (60-70)

Question 16

What female cancer is directly comparable with testicular seminomas?

Answer 16

Ovarian dysgerminoma

Question 17

What accounts for the majority of cases of ovarian GCTs?

Answer 17

Ovarian dysgerminoma

Question 18

What % of patients present with seminoma/dysgerminoma confined to the testis/ovary?

Answer 18

75%

Question 19

Describe the spread of seminoma/dysgerminoma?

Answer 19

It is usually predictable, from the para-aortic to supra-diaphragmatic nodes, and then to extranodal sites

Question 20

What is the result of the growth of seminoma/dysgerminoma being slow?

Answer 20

It may take up to 10 years to present clinically

Question 21

Do seminomas/dysgerminomas produce tumour markers?

Answer 21

They do not produce a reliable tumour marker, but hCG can be elevated in 10-25% of cases

Question 22

How do non-seminoma GCT compare to seminomas, in terms of spread?

Answer 22

Disease spread occurs earlier

Question 23

What is the result of disease spread occuring earlier in non-seminoma GCTs?

Answer 23

Only 50% of patients present with localised disease

Question 24

What tumour markers are associated with non-seminoma GCTs?

Answer 24

AFP and hCG

Question 25

What % of cases of non-seminoma GCTs have elevated AFP and hCP?

Answer 25

75%

Question 26

How do testicular GCTs present?

Answer 26

• Painless solid mass in scrotum
• Enlargement of testicle
• Scrotal pain (i guess the actual lump doesnt hurt, but the scrotum does?)
• Back pain
• Dragging sensation in scrotum
• Gynaecomastia

Question 27

What causes gynaecomastia in testicular GCTs?

Answer 27

High circulating hCG levels

Question 28

What might the presenting features of testicular GCTs be similar to?

Answer 28

Epididymo-orchitis

Question 29

When should epididymo-orchitis raise suspicion of testicular GCT?

Answer 29

If it does not respond to antibiotics