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Flashcards in Testicular Cancer Deck (11):

What age range is at highest risk of testicular cancer

15-45 year old males


What are the risk factors for testicular cancer and how do these affect investigations

Maldescent of testes
Testicular atrophy
Family history

Risk of bilateral disease - biopsy bilaterally


What are the most common histological types of testicular cancer

Germ cell tumour - 95%
Lymphoma - 4%
Leydig/sertoli - 1%

Germ cell rumours may be:
Seminomatous- 40%
Non Seminomatous - 60%
- Teratoma
- combined
- yolk sac


How does testicular cancer spread and which organs and nodes does it spread to?

Lymphatic spread to para aortic nodes
Metastatic to lungs, liver, bone, brain


Investigations in testicular cancer

Testicular ultrasound
This can differentiate between solid and fluid filled lesions, as well as seminomas and teratomas

Tumour markers
BHCG, AFP raised in non seminoma, LDH to assess prognosis

Tumour markers and ultrasound together decide whether orchidectomy is necessary to confirm pathology

CT for staging


Royal marsden staging

1- confined to testicle
2- para aortic nodes below diaphragm
3- para aortic nodes above diaphragm
4- visceral metastases


Why is the approach through the inguinal canal in orchidectomy for testicular cancer

To reduce spread through the scrotal tissue planes


What adjuvant chemotherapy is used with orchidectomy in stage 1 testicular cancer

Seminoma - one dose carboplatin
Non seminoma - 2 cycles BEP

BEP is bleomycin, etoposide, cisplatin


What chemotherapy is used metastatic testicular cancer

3-4 cycles BEP

Second line is reinduction with taxane chemo

High dose chemo with peripheral stem cell support may be considered if poor prognosis


When is surveillance only an option in testicular cancer?

Low risk stage one testicular cancer


When is radiotherapy used in testicular cancer

Adjuvant therapy to para aortic nodes in stage one disease

Debulking radiotherapy in malignant teratoma

Palliative to brain, bone, nodes