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37 Cards in this Set
- Front
- Back
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Testicular cancer is more common in what race and on what side of the body?
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More common in White American men and more common on the right side.
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What are the risk factors associated with testicular cancer?
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History of Cryptorchidism - 7-10 times greater, 1:20 with abdominal cryptorchidism, 1:80 with inguinal cryptorchidism
Prior Hx of Testicular Cancer Family History Race Genetics Occupation HIV |
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What about genetics specifically is an increased risk factor for testicular cancer?
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Klinefelter's Syndrome (47XXY) = Low Testosterone
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What specific occupations have a high risk factor for testicular cancer?
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Miners
Oil and Gas Workers Leather Workers |
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What is the classical presentation of testicular cancer?
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Painless nodule or testicular mass, most commonly identified by the patient.
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What are three things associated with a typical clinical presentation of testicular cancer?
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Testicular discomfort or feeling of heaviness
Swelling or fluid collection in the scrotum Enlargement of the testis |
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What are some of the less common presentations of testicular cancer?
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Gynecomastia - due to elevation of HCG levels.
Metastatic Signs |
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What type of testicular cancer tumors are associated with gynecomastia due to an elevation of HCG levels.
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Associated with Germ Cell Tumors.
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What are the three metastatic signs of testicular cancer?
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Back Pain
Cough Supraclavicular Lymphadenopathy |
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What specific metastatic sign must you absolutely rule out testicular or any other cancer?
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Supraclavicular lymphadenopathy
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These make up 90-95% percent of testicular cancer?
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Germ cell tumors
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What three types of germ cell tumors develop from the sperm producing germ cells?
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Seminomas
Nonseminomas Mixed |
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These account for approximately 50% of all testicular cancers. They typically grow slowly and metastasize late if at all.
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Seminoma - Germ Cell Tumor
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What are the four types of Nonseminomas
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Embryonal
Choriocarcinoma Teratomas Yolk Sac |
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These are aggresive, grow and metastasize early and may increase both alpha fetoprotein and beta HCG.
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Embryonal - Nonseminomas - Germ Cell Tumors
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These are very aggressive and associated with elevations of beta HCG.
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Choriocarcinoma - Nonseminomas - Germ Cell Tumors
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These Germ Cell nonseminomas tumors form from embryological development.
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Teratomas - Germ Cell Tumors - Nonseminomas
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This form of testicular cancer is most common in infants and young boys, it is associated with elevation of alpha-fetoprotein, usually are successfully treated in children.
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Yolk Sac - Germ Cell Tumors - Nonseminomas
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These account for 5-10% of all testicular cancers and they develop in the hormone producing tissues of the testicles, ie. Leydig and Sertoli Cells.
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Nongerminating Cell Tumors
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Most of these cases are in adult men, often produce androgens but may also produce estrogen, most do not spread, poor prognosis if metabolic disease is present, also associated with precocious puberty.
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Leydig Cell - Nongerminating Cell Tumor
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These are usually benign and there is only a poor prognosis if metastic disease is present.
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Sertoli Cells - Nongerminating Cell Tumor
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What are the diagnostic tools for diagnosing testicular cancer?
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Ultrasound
Tumor Markers |
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What are the two tumor markers used to diagnose testicular cancer?
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Alpha-fetoprotein (AFP)
Human chorionic gonadotropin (HCG) |
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With seminoma what are the tumor marker outcomes?
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AFP = Negative
HCG = Positive |
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With nonseminomas what are the tumor marker outcomes?
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AFP = Positive
HCG = Positive |
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With Sertoli cell what are the tumor marker outcomes?
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AFP = Negative
HCG = Negative |
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With Leydig cell what are the tumor maker outcomes?
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AFP = Negative
HCG = Negative |
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In this stage of the MD Anderson staging system for Testicular cancer the cancer is limited to the testis, epididymis or spermatic cord.
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Stage A (I)
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In this stage of the MD Anderson staging system for Testicular cancer the spread is limited to retroperitoneal (regional) lymph nodes.
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Stage B (II)
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In this stage of the MD Anderson staging system for Testicular cancer the disease spread is beyond the retro-peritoneum involving supradiaphragmatic nodal sites or viscera.
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Stage C (III)
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What is the primary Tx of testicular cancer?
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Surgery:
Removal of the testical (radical inguinal orchiectomy) +/- Retroperitoneal lymph node dissection +/- Testicular implant |
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What is the adjunctive Tx options for testicular cancer?
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Radiation
Chemotherapy |
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This is used predominately to kill cancer cells that have spread to regional lymph nodes. Seminomas are highly sensitive to this particular Tx.
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Radiation
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This is effective for cancer cells in distant lymph nodes or organs.
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Chemotherapy
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What is meant to be done in year one after tx testicular cancer?
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Monthly follow up with PE, repeat tumor makers and chest x-ray, +/- abdominal CT
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What is meant to be done in year two after tx testicular cancer?
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Follow up every 2 months, with PE, tumor markers and chest x-ray, +/- abdominal CT every 4 months.
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What is meant to be done in years III-V after Tx testicular cancer?
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Follow up every 6 months with PE, tumor markers, chest X-ray, +/- abdominal CT every 6 months. After year five you can just do a yearly follow up.
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