Testicular Cancer

Overview

• Testicular cancer originates from germ cells in the testes.
• Germ cells produce gametes (sperm in testes).
• Other types:
  • Non-germ cell tumors
  • Secondary metastases
• More common in young men (15-35 years).

Types of Testicular Cancer

• Seminomas
• Non-seminomas: Mostly teratomas

Risk Factors

1. Undescended testes
2. Male infertility
3. Family history of testicular cancer
4. Increased height (taller individuals)

Presentation

• Painless lump in the testicle
  • May feel hard and irregular
  • Non-tender, possibly numb
  • Doesn't fluctuate or transluminate
• Testicular pain (occasionally)
• Gynecomastia (rarely, particularly with Leydig cell tumors)
  • 2% with gynecomastia may have a testicular tumor

Investigations

• Scrotal ultrasound scan: Initial diagnosis
• Tumor markers:
  • Alpha-fetoprotein: Raised in teratomas, not in pure seminomas
  • Beta-HCG: May be raised in both teratomas and seminomas
  • Lactate dehydrogenase (LDH): Non-specific marker
• Staging CT scan: To assess spread and stage cancer

Staging - Royal Marsden Staging System

• Stage 1: Isolated to testicle
• Stage 2: Spread to retroperitoneal lymph nodes
• Stage 3: Spread to lymph nodes above diaphragm
• Stage 4: Metastasized to other organs

Common Metastasis Sites

• Lymphatic system
• Lungs
• Liver
• Brain

Management

• Guided by multi-disciplinary team (MDT)
• Surgery: Radical orchidectomy (removal of affected testicle)
  • Prosthesis option for normal appearance
• Additional Treatments:
  • Chemotherapy
  • Radiotherapy
  • Sperm banking (to prevent infertility)
• Long-term side effects:
  • Infertility
  • Hypogonadism (may require testosterone replacement)
  • Peripheral neuropathy
  • Hearing loss
  • Potential kidney, liver, or heart damage
  • Increased risk of future cancer

Prognosis

• Early testicular cancer: >90% cure rate
• Metastatic disease: Often curable
• Seminomas: Slightly better prognosis than non-seminomas
• Follow-up:
  • Monitor tumor markers
  • Imaging (CT scans, chest X-rays)

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