Testicular cancer
Cards (9)
- Overview:
- The most common malignancy in men aged 15-45 years
- Overall it is a rare malignancy
- If diagnosed early, has a 5-year survival rate of 95%
- Classification:
- Majority are derived from germ cells (cells that make sperm) and further classified into
- Seminomas
- Non-seminomas
- The rest are non-germ cell tumours e.g. leydig and sertoli cell tumours
- Risk factors:
- Cryptorchidism
- Family history
- Hypospadias
- Klinefelter's syndrome
- Symptoms:
- Unilateral painless testicular lump - irregular, firm and fixed
- Sometimes secondary hydrocele if testicular capsule involved
- Sometimes there can be testicular pain/discomfort
- Spread via lymphatics to para-aortic nodes around L1/2 so can have back pain and abdominal mass on palpation
- If metastases - weight loss, back pain and dyspnoea (lung mets)
- Assessment of a testicular lump should include the 6 Ss:
- Site
- Size
- Shape
- Symmetry
- Skin change
- Scars
- Tumour markers:
- Can be diagnostic and prognostic but negative markers do not exclude testicular cancer
- Good for monitoring recurrence post operatively
- Beta HCG - can be raised in any type of germ cell tumour
- AFP - only non germ cell tumours
- LDH - general marker of cell turnover
- Referral:
- 2WW referral in men with non-painful enlargement or change in shape or texture of testis
- Also consider malignancy in:
- New hydrocele aged 18-40 years
- Unexplained retroperitoneal mass or complication of retroperitoneal mass e.g. varicocele that appears suddenly and is painful, does not drain when lying down, or solitary right sided
- Imaging:
- Testicular ultrasound - need to look at both testes to ensure no bilateral disease
- If ultrasound suggests malignancy surgery is arranged - orchidectomy is diagnostic as can test tissue from testicle and therapeutic as removes cancer
- CT CAP with contrast for staging
- Management:
- MDT discussion
- Radical inguinal orchidectomy - removal of the testicle, epididymis and spermatic cord up to the level of the internal inguinal ring
- Counsel patients on sperm banking and cryopreservation as well as testicular prosthesis
- Tumour staging and histopathological results guide further management with options including surveillance, chemotherapy, radiotherapy