Flashcards in Testicular Deck (13):
What are some risk factors for testicular cancer?
Cryptorchism (higher risk for abdominal then ingiunal)
Clinical,features of testicular cancer?
Firm rubbery lump, some present with acutely painful testicle
Symptoms from metastatic disease - back pain, sob, CNS
Paraneoplastic limbic encephalitis
Gynaecomastiamifmhigh production of BHCG
Diagnosis of testicular cancer?
CT abdo/ pelvis (chest if symptoms or CXR abnormal)
Tumour markers (LDH, B hCG, AFP)
CNS imaging if symptoms
Removal of testis for histology
What are the differences between NSGCT (nonseminoma) and seminoma?
- contain either embryonal, choriocarcinoma, yolk sac tumour, teratoma or a mixture
- if AFP is high can only be NSGCT (produced by yolk sac cells)
- tend to be more aggressive, present at a more advanced stage
- most present with localised disease
- BHCG and LDH can be raised but not AFP
- consist of only pure seminoma (if any other component = NSGCT)
- metastases less through blood to distant sites then NSGCT
What are the risk stratification for advanced seminoma?
Intermediate risk - have metastasis outside of lung and lymph nodes
What is the risk stratification for advanced non-seminoma?
Good risk - pulmonary or nodal risk with low tumour markers
Poor risk - metastases other then lung and nodes + higher tumor markers
What is the staging for Testicular germ cell tumors?
Stage 1 - localised to testis
Stage 2 - localised to lymph nodes
Stage 3 - metastatic disease
What subtypes make up testicular cancer?
Germ cell tumours = seminoma and nonseminoma
Sex cord stromal tumors (Leidig, Sertoli cell)
Lymphoma and metastatic disease from other primaries
What is the treatment of seminoma following orchiectomy?
Stage 1 - surveillance is preferred, however if high risk features (rete testis invasion + large tumour greater then 4cm) can consider single dose carboplatin
Advanced disease - 3-4 cycles of BEP chemotherapy (Bleomycin/etoposide/cisplatin) followed by resection of residual disease
What is the treatment of non-seminoma following orchiectomy?
Stage 1 - surveillance vs retroperiotneal lymph node dissection vs 1-2 cycles BEP (later 2 options for higher risk disease
Advanced - 3-4 cycles BEP chemotherapy
Resection of residual masses
What is the prognosis of testicular cancer?
Good risk TGCT - 5 year OS 92%
Poor risk NSGCT - 5 year OS 48%
What is the feared side effect of bleomycin?
Lung toxicity - pulmonary fibrosis with oxygen toxicity (worsening of fibrosis with high flow oxygen administration)
Need regular Lung function tests