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ALL / Nephrology
Testicular cancer
Testicular cancer
Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours. Germ cell tumours may essentially be divided into:- seminomas
- non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma
Non-germ cell tumours include Leydig cell tumours and sarcomas.
The peak incidence for teratomas is 25 years and seminomas is 35 years. Risk factors include:
- infertility (increases risk by a factor of 3)
- cryptorchidism
- family history
- Klinefelter's syndrome
- mumps orchitis
Features
- a painless lump is the most common presenting symptom
- pain may also be present in a minority of men
- hydrocele
- gynaecomastia
- this occurs due to an increased oestrogen:androgen ratio
- germ-cell tumours → hCG → Leydig cell dysfunction → increases in both oestradiol and testosterone production, but rise in oestradiol is relatively greater than testosterone
- leydig cell tumours → directly secrete more oestradiol and convert additional androgen precursors to oestrogens
Tumour markers
- germ cell tumours
- seminomas: seminomas: hCG may be elevated in around 20%
- non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
- LDH is elevated in around 40% of germ cell tumours
Diagnosis
- ultrasound is first-line
Management
- treatment depends on whether the tumour is a seminoma or a non-seminoma
- orchidectomy
- chemotherapy and radiotherapy may be given depending on staging and tumour type
Prognosis is generally excellent
- 5 year survival for seminomas is around 95% if Stage I
- 5 year survival for teratomas is around 85% if Stage I
+PassMedicine Notes
Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours. Germ cell tumours may essentially be divided into:
- seminomas
- non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma
Non-germ cell tumours include Leydig cell tumours and sarcomas.
The peak incidence for teratomas is 25 years and seminomas is 35 years. Risk factors include:- infertility (increases risk by a factor of 3)
- cryptorchidism
- family history
- Klinefelter's syndrome
- mumps orchitis
- a painless lump is the most common presenting symptom
- pain may also be present in a minority of men
- hydrocele
- gynaecomastia
- this occurs due to an increased oestrogen:androgen ratio
- germ-cell tumours --> hCG --> Leydig cell dysfunction --> increases in both oestradiol and testosterone production, but rise in oestradiol is relatively greater than testosterone
- leydig cell tumours --> directly secrete more oestradiol and convert additional androgen precursors to oestrogens
- germ cell tumours
- seminomas: seminomas: hCG may be elevated in around 20%
- non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
- LDH is elevated in around 40% of germ cell tumours
- ultrasound is first-line
- treatment depends on whether the tumour is a seminoma or a non-seminoma
- orchidectomy
- chemotherapy and radiotherapy may be given depending on staging and tumour type
- 5 year survival for seminomas is around 95% if Stage I
- 5 year survival for teratomas is around 85% if Stage I
