[Music] [Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through testicular cancer and you can find written notes on this topic at zero to finals dot com slash testicular cancer or in the urology section of the zero to finals surgery book so let's jump straight in testicular cancer arises from the germ cells in the testes germ cells are cells that produce gametes and in the testicles the gametes are the sperm there are other rarer tumors in the testes such as non-germ cell tumors and secondary metastases testicular cancer is more common in younger men with the highest incidence being between 15 and 35 years old testicular cancer can be divided into two types seminomas and non-seminomas which are mostly types of cancer called teratomas there are four risk factors that increase the risk of testicular cancer to remember undescended testes male infertility family history of testicular cancer and increased height so taller people are at an increased risk let's talk about the presentation the typical presentation is with a painless lump that's been felt on the testicle occasionally it can present with testicular pain the lump will be non-tender or even have a reduced sensation feeling a bit numb on palpation it will arise from the testicle and it will feel hard and irregular it's also not fluctuate and you can't transluminate testicular cancer rarely gynecomastia or breast enlargement can be a presentation of testicular cancer particularly a rare type of tumor called a lady cell tumor about two percent of patients presenting with gynecomastia will have a testicular tumor let's talk about the investigations a scrotal ultrasound scan is the usual initial investigation to confirm the diagnosis tumor markers for testicular cancer are alpha feta protein which may be raised in teratomas but not in pure seminomas beta-hcg which may be raised in both teratomas and seminomas and lactate dehydrogenase or ldh which is very non-specific as a tumor marker a staging ct scan can be used to look for areas where the cancer has spread and to stage the cancer let's talk about the royal marsden staging system testicular cancer can be staged with the royal marsden staging system stage 1 is where it's isolated to the testicle stage 2 is where it's spread to the retroperitoneal lymph nodes stage three is where it's spread to the lymph nodes above the diaphragm and stage four is where it's metastasized to other organs so let's talk more about the metastases the common places for testicular cancer to metastasize to are the lymphatic system the lungs the liver and the brain let's talk about management management of any cancer is guided by the multi-disciplinary team or mdt meeting and this is to decide the best course of action for the individual patient depending on the stage and the grade of the testicular cancer treatment can involve surgery to remove the affected testicle called a radical orchidectomy if the testicle is removed a prosthesis can be put in its place to give a normal appearance and feel to the scrotum treatment can also involve chemotherapy radiotherapy and sperm banking to save the sperm for future use as treatment of testicular cancer can cause infertility long-term side effects of treatment are particularly significant with testicular cancer as most patients are young and expected to live many years after treatment side effects of treatment include infertility hypogonadism and testosterone replacement may be required treatment can also cause peripheral neuropathy hearing loss lasting kidney liver or heart damage and an increased risk of cancer in the future finally let's talk about the prognosis the prognosis for early testicular cancer is good with a greater than 90 cure rate metastatic disease is also often curable seminomas have a slightly better prognosis than non-seminomas patients will require follow-up to monitor for any reoccurrence of the cancer and this usually involves monitoring the tumor markers and it may involve imaging such as ct scans or chest x-rays if you like this video consider joining the zero to finals patreon account where you get early access to these videos before they appear on youtube you also get access to my comprehensive course on how to learn medicine and do well in medical exams digital flashcards for rapidly testing the key facts you need for medical exams early access to the zero to finals podcast episodes and question podcasts which you can use to test your knowledge on the go thanks for watching and i'll see you in the next video