9- Testicular tumors
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Questions and Answers

What is the recommended approach for a patient with low-volume NSGCT and elevated serum markers?

  • Surveillance with CT scans
  • Immediate surgical resection
  • Nerve-sparing RPLND
  • Chemotherapy with BEP for 3 cycles (correct)

Which follow-up procedure is typically conducted every one to three months for patients recovering from testicular cancer?

  • PET scan of the brain
  • MRI of the pelvis
  • Bone marrow biopsy
  • Physical examination and chest x-ray (correct)

What is a common long-term side effect of bleomycin used in cancer treatment?

  • Testosterone increase
  • Hearing loss
  • Lung damage (correct)
  • Kidney damage

Which treatment approach is typically followed for a residual mass greater than 1 cm if tumor markers are normal?

<p>Surgical resection (A)</p> Signup and view all the answers

What is the primary goal of regular follow-up for testicular cancer patients?

<p>To detect relapse and asynchronous tumors early (D)</p> Signup and view all the answers

What is the percentage of all cancers in men that testicular cancer accounts for?

<p>1-1.5% (C)</p> Signup and view all the answers

Which risk factor is NOT associated with an increased risk of developing testicular cancer?

<p>Obesity (C)</p> Signup and view all the answers

Which type of germ cell tumor is most likely to present in a younger male population?

<p>Classical seminoma (B)</p> Signup and view all the answers

What is the primary characteristic of spermatocytic seminomas compared to classical seminomas?

<p>Less likelihood of metastasis (C)</p> Signup and view all the answers

Which region of the body is least likely to develop germ cell tumors from the testicles?

<p>Cervical spine (B)</p> Signup and view all the answers

What percentage of testicular tumors are pure embryonal carcinomas?

<p>3-4% (B)</p> Signup and view all the answers

Which statement about testicular tumors is accurate regarding their treatment?

<p>Mixed germ cell tumors are treated as non-seminomas (C)</p> Signup and view all the answers

In which demographic is testicular cancer most frequently diagnosed?

<p>Men aged 20 to 45 (B)</p> Signup and view all the answers

Which protein is produced by nonseminomas and is used to track the patient’s response to treatment?

<p>Alpha-fetoprotein (C)</p> Signup and view all the answers

What characteristic best describes choriocarcinoma?

<p>It is likely to metastasize rapidly to distant organs. (B)</p> Signup and view all the answers

Which type of teratoma is more likely to invade surrounding tissues?

<p>Immature teratomas (D)</p> Signup and view all the answers

What is the typical initial diagnosis method for carcinoma in situ (CIS) in testicular cancer?

<p>Biopsy (C)</p> Signup and view all the answers

What distinguishes teratoma with malignant transformation from other teratoma types?

<p>It shows aggressive characteristics and can develop outside the testicle. (C)</p> Signup and view all the answers

Which of the following statements about mature teratomas is true?

<p>They can usually be cured with surgery. (A)</p> Signup and view all the answers

What is the most common treatment recommendation for carcinoma in situ due to its unpredictable nature?

<p>Observation (watchful waiting) (D)</p> Signup and view all the answers

Which of the following is NOT a typical outcome of nonseminomas?

<p>High likelihood of developing into choriocarcinoma (C)</p> Signup and view all the answers

What distinguishes immature teratomas from mature teratomas?

<p>Immature teratomas contain cells resembling early embryonic cells. (B)</p> Signup and view all the answers

What percentage of testicular tumors in children are Leydig cell tumors?

<p>25% (B)</p> Signup and view all the answers

Which of the following statements is true regarding Sertoli cell tumors?

<p>They are usually benign. (B)</p> Signup and view all the answers

In adulthood, what is the most common secondary testicular cancer?

<p>Testicular lymphoma (B)</p> Signup and view all the answers

What is the primary treatment for secondary testicular tumors?

<p>Surgical removal followed by radiation and/or chemotherapy (A)</p> Signup and view all the answers

What is a common symptom of testicular cancer?

<p>Painless lump in the testicle (D)</p> Signup and view all the answers

Which of the following best describes the progression of metastatic spread in testicular cancer?

<p>It can involve para aortic nodes, lungs, and bones. (C)</p> Signup and view all the answers

Which diagnostic method is NOT typically used for testicular cancer staging?

<p>MRI of the pelvis (A)</p> Signup and view all the answers

Which serum markers are commonly assessed in suspected testicular cancer cases?

<p>AFP, bhCG, and LDH (C)</p> Signup and view all the answers

What is a major reason for delayed diagnosis of testicular cancer?

<p>Failure to perform self-examination (C)</p> Signup and view all the answers

What characterizes Leydig cell tumors of the testicle?

<p>They sometimes produce estrogens (D)</p> Signup and view all the answers

What is the prognosis for patients classified under the poor-risk category for advanced testicular cancer?

<p>Approximately 50% chance of successful treatment (B)</p> Signup and view all the answers

Which of the following factors does NOT influence the prognosis and treatment options for testicular cancer?

<p>Number of surgical interventions previously undergone (C)</p> Signup and view all the answers

What is the recommended treatment for clinical Stage IA NSGCT?

<p>Nerve-sparing retroperitoneal lymph node dissection (RPLND) or primary chemotherapy (A)</p> Signup and view all the answers

What is the treatment protocol for a patient diagnosed with low-volume seminoma at Stage II?

<p>Radiotherapy (30-36 Gy); chemotherapy as salvage therapy if needed (C)</p> Signup and view all the answers

For high volume seminoma at Stage II, what is the recommended treatment approach?

<p>3 cycles of BEP chemotherapy (A)</p> Signup and view all the answers

In Stage III testicular cancer, what signifies a more advanced stage of the disease?

<p>Metastasis to lungs, liver, brain, and bones (A)</p> Signup and view all the answers

What is the purpose of conducting nerve-sparing retroperitoneal lymph node dissection (RPLND) in clinical Stage IB NSGCT?

<p>To evaluate lymph node disease and determine further treatment (D)</p> Signup and view all the answers

In the context of advanced testicular cancer, what does the term ‘good-risk’ refer to?

<p>Patients with a high probability of treatment success (B)</p> Signup and view all the answers

Which of the following is a key marker evaluated for testicular cancer prognosis?

<p>Lactate dehydrogenase (LDH) (D)</p> Signup and view all the answers

Flashcards

Testicular cancer

A relatively rare cancer in young men, highly treatable and often curable, mainly affecting germ cells.

Risk factors for testicular cancer

Factors associated with a higher chance of developing testicular cancer, including age, family history, past testicular cancer, race, cryptorchidism, Klinefelter's syndrome, HIV, and maternal estrogen exposure.

Germ cell tumors

Most common type of testicular cancer, starting in cells that produce sperm.

Seminomas

A type of germ cell tumor

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Non-seminomas (NSGCT)

Another type of germ cell tumor, which includes subtypes like embryonal carcinoma and yolk sac carcinoma.

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Embryonal carcinoma

A type of NSGCT that often grows and spreads quickly.

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Yolk sac carcinoma

A type of NSGCT, most common in children, originating from cells similar to the yolk sac of an early human embryo.

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Cryptorchidism

A medical condition where one or both testicles don't descend into the scrotum, increasing the risk of testicular cancer.

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Stage III Testicular Cancer

Cancer has spread to other parts of the body, including the lungs, liver, brain, and bones.

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Good-Risk Testicular Cancer

This group has a high chance of successful treatment due to factors like tumor size, location, and stage.

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Poor-Risk Testicular Cancer

This group has a more challenging prognosis, but even with poor-risk disease, there is about a 50% chance of successful treatment.

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Prognosis in Testicular Cancer

The prognosis is determined by factors like the stage of the cancer, tumor size, type of cancer, and blood levels of certain markers (AFP, β-hCG, and LDH).

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Stage I Seminoma

This stage involves only the testicle, and treatment options include para-aortic prophylactic radiotherapy, surveillance, or carboplatin-based chemotherapy.

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Stage I NSGCT (Non-Seminoma)

This type can be treated with surveillance, nerve-sparing RPLND, primary chemotherapy, or adjuvant chemotherapy based on the level of vascular invasion.

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Stage II Seminoma

This stage involves spread to the nearby lymph nodes, with treatment options including radiotherapy or chemotherapy depending on cancer volume.

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Stage II NSGCT (Non-Seminoma)

Treatment typically involves chemotherapy, surgical removal of lymph nodes, or a combination of both, based on risk factors.

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Para-Aortic Prophylactic Radiotherapy

A treatment option for Stage I Seminoma involving radiation aimed at the lymph nodes along the aorta.

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Nerve-Sparing RPLND (Retroperitoneal Lymph Node Dissection)

A surgical procedure to remove lymph nodes in the abdomen, aiming to preserve nearby nerves important for sexual function.

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Alpha-fetoprotein (AFP)

A protein released into the bloodstream by certain types of testicular cancer, used to confirm diagnosis and track treatment response.

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Human Chorionic Gonadotropin (HCG)

A hormone produced by choriocarcinoma, a type of testicular cancer, used to confirm diagnosis and monitor treatment effectiveness.

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Mature Teratoma

A type of testicular tumor made of cells similar to adult tissues, rarely spreads, and usually curable with surgery.

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Immature Teratoma

A testicular tumor with cells resembling those of an early embryo, more likely to spread and grow into surrounding tissues.

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Teratoma with Malignant Transformation

A rare type of testicular tumor with areas resembling mature teratoma, but other areas where cells become cancerous and spread outside the testicle.

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Carcinoma in situ (CIS)

A non-invasive form of testicular germ cell cancer that may not always progress to invasive cancer, found incidentally during biopsy for infertility.

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Watchful waiting

The best treatment option for CIS because it may not always become invasive cancer.

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Stromal Tumors

Testicular tumors that develop in the supportive and hormone-producing tissues of the testicles, not from germ cells.

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What is the main difference between mature and immature teratomas?

Mature teratomas are composed of cells similar to adult tissues, rarely spread and are usually curable with surgery. Immature teratomas contain cells resembling those of an early embryo, are more likely to grow and spread into surrounding tissues.

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Why is alpha-fetoprotein (AFP) important for testicular cancer?

AFP is a protein released into the bloodstream by certain types of testicular cancer, specifically nonseminomas. Levels of AFP can help confirm a diagnosis of these cancers and track the patient’s response to treatment.

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Leydig Cell Tumor

A tumor developing from Leydig cells in the testicle, responsible for androgen production. It can occur in both adults and children, and sometimes secretes estrogens.

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Sertoli Cell Tumor

A tumor arising from Sertoli cells, which support the sperm-producing cells. Usually benign, but can spread and be resistant to chemotherapy and radiation.

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Secondary Testicular Tumors

Tumors that spread to the testicles from other parts of the body, often originating from lymphomas, leukemias, or cancers like prostate, lung, skin, or kidney.

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Testicular Lymphoma

The most common secondary testicular cancer in men over 50. Usually requires surgical removal followed by radiation or chemotherapy.

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Testicular Metastasis

The spread of cancer from the testicle to other parts of the body, commonly affecting para-aortic nodes, lungs, brain, and bones.

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Why Diagnosis Delay?

Testicular cancer diagnosis can be delayed due to factors like lack of self-examination, avoiding medical visits, and delayed diagnosis by healthcare professionals.

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Testicular Cancer Presentation

Symptoms of testicular cancer can include a painless lump, possible pain after trauma, breast tenderness or growth, or metastasis symptoms like back pain, chest pain, and shortness of breath.

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Differential Diagnosis (DD) of Testicular Cancer

It is important to differentiate testicular cancer symptoms from other conditions like hydrocoele, spermatocoele, scrotal cysts, infections, and injuries.

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Testicular Ultrasound

A diagnostic imaging technique using sound waves to visualize the testicle, helping to detect tumors and other abnormalities.

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Serum Markers for Testicular Cancer

Blood tests that measure the levels of AFP, bhCG, and LDH, which can be elevated in testicular cancer and help in diagnosis and monitoring.

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Residual tumor after surgery

A small amount of cancer tissue that might remain after surgery, often smaller than 1cm, and sometimes doesn't require further treatment.

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NSGCT treatment: Low volume, elevated markers

For non-seminomatous germ cell tumors (NSGCT) with small tumor size but high blood marker levels, chemotherapy (3 cycles of BEP) is preferred. This targets the cancer cells even if they're not visible.

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Good prognosis NSGCT treatment

For NSGCT with a favorable chance of recovery, 3 cycles of BEP chemotherapy is the standard treatment.

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Follow-up after testicular cancer: Why?

Regular check-ups are crucial to identify any recurrence of the cancer early on. This minimizes the need for extensive treatments and helps catch new cancer in the other testicle.

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Testicular cancer follow-up schedule

Initial follow-ups occur every 1 to 3 months for the first 1 to 2 years, involving physical exams, chest x-rays, blood tests, and CT scans.

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Study Notes

Testicular Tumors

  • Testicular cancer is a common solid tumor in young men, affecting them in their 30s and 40s.
  • It's relatively rare, comprising 1-1.5% of all cancers in men.
  • It's highly treatable and often curable.
  • Testicles have different cell types, each potentially developing cancer with varying prognoses and treatments.

Testicular Cancer Risk Factors

  • Age: Most prevalent between 20 and 45.
  • Family history: Increased risk with family history.
  • Personal history: Having cancer in one testicle raises the risk in the other.
  • Race: White men have a higher rate of diagnosis.
  • Cryptorchidism: Undescended testicles increase risk.
  • Klinefelter syndrome: Extra X chromosome; lowers male hormones, affecting fertility, and increasing risk of germ cell tumors.
  • HIV infection: HIV infection linked to an increased risk.
  • Maternal estrogen exposure: Potential link to increased risk.

Testicular Cancer Pathology

  • Over 90% of testicular cancers originate in germ cells (sperm-producing cells).
  • Germ cell tumors commonly begin in the testicles but can spread to other parts of the body (retroperitoneum, mediastinum, lower spine, pineal gland).
  • Two main types of germ cell tumors:
    • Seminomas
    • Non-seminomas (NSGCT)
    • Some cancers contain both, treated as non-seminomas.

Seminomas

  • Two main subtypes:
    • Classical (typical): Most common, affecting men in their late 30s to early 50s.
    • Spermatocytic: Affects older men (55+). Tends to grow more slowly and isn't as likely to spread as classical seminomas.

Non-seminomas (NSGCT)

  • Embryonal carcinoma: Accounts for about 40% of testicular tumors overall, but pure embryonal carcinomas are rare (~3-4%). Grows quickly and spreads outside the testicle.
  • Yolk sac carcinoma: Most common in children. Looks like the yolk sac of a human embryo. Highly responsive to chemotherapy. AFP protein, found in the blood, helps diagnose and track treatment.
  • Choriocarcinoma: Very rare and aggressive. Often affects adults. Highly likely to spread to distant organs (lungs, bones, brain). Less common as a pure form. Usually found with other tumor types. HCG protein used for diagnosis and treatment monitoring.

Mature and Immature Teratomas

  • Mature teratomas: Formed from adult tissue cells. Spread is infrequent, surgery is typical treatment.
  • Immature teratomas: Cells resemble early embryo tissue, increasing the likelihood of invasion and spread beyond the testicle. Can recur years post-treatment.
  • Teratomas with malignant transformation: Highly rare. Some tissue areas may change to cancer types that originate elsewhere in the body (muscles, lungs, intestines, brain).

Carcinoma in Situ (CIS)

  • Early stage of testicular cancer, non-invasive.
  • Found with biopsies, often incidentally.
  • Doesn't always progress to invasive cancer, observation or watchful waiting is sometimes the best strategy.

Stromal Tumors

  • Less common, about 4% of adult cases but account for up to 20% in children.
    • Leydig cell tumors: Originate from Leydig cells, produce androgens and sometimes estrogen. Often localized and cured with surgery. Poor prognosis if they spread.
    • Sertoli cell tumors: Develop from Sertoli cells supporting germ cells. Usually non-cancerous; resistance to chemotherapy and radiation if they spread.

Secondary Testicular Tumors

  • Other cancers can spread to the testes from other sites.
  • Testicular lymphoma is common in older men (over 50).
  • Prognosis depends upon the specific cancer type and stage.
  • Leukemia cells can occasionally form tumors in the testes.

Testicular Cancer Metastatic Spread

  • Common routes include para-aortic nodes, lungs, brain, and bones.
  • Retroperitoneal nodes are often involved.

Testicular Cancer Diagnosis Delay

  • Patient avoids self examination and medical attention.

Testicular Cancer Staging

  • Stage 0 (Carcinoma in situ): Early, non-invasive cancer.
  • Stage I: Cancer limited to the testes.
  • Stage II: Cancer has spread to lymph nodes in the abdomen.
  • Stage III: Cancer has spread to other body organs such as lungs, liver, brain, and bones.
  • Specific staging systems (e.g. TNM, Walter Reed) exist to precisely document aspects of the disease.
  • Multiple staging, or tumor, markers (i.e. LDH, AFP, βhCG) aid in diagnosis and prognosis.

Testicular Cancer Treatment Options

  • Treatment protocols depend on: stage, type of cancer, tumor size, and existence and extent of retroperitoneal lymph nodes.
  • Risk group classification based on treatment success rates (e.g., good, intermediate, poor).
    • Poor-risk cancers retain a 50% chance of successful treatment.
  • Specific treatment (surgery, radiation, chemotherapy) depends on the type and stage for seminomas and nonseminomas.

Testicular Cancer Follow-up

  • Crucial for early detection of relapse.
  • Frequency and duration of follow-ups depend on the cancer histology, stage and specific treatment approach.
  • A key goal of follow-up is to detect possible secondary or synchronous cancers in the other testicle.

Testicular Cancer Side Effects

  • Anemia
  • Diarrhea
  • Hormone deprivation (men)
  • Infections
  • Nervous system disturbances
  • Sexual dysfunction
  • Skin problems
  • Long-term effects: lung, kidney, blood vessel damage, hearing and nerve damage
  • Secondary cancers
  • Infertility
  • Testosterone level effects

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Testicular Tumors PDF

Description

This quiz covers essential information about testicular tumors, including their prevalence, risk factors, and pathology. Learn about the different types of cells involved and how family history and other conditions can influence risk. Gain insights into this important health topic relevant for young men.

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