Terms in this set (21)
What is the incidence?
Rare; 2 to 3 new cases per 100,000 men per year in the United States
What is its claim to fame?
Most common solid tumor of young adult males (20 to 40 years)
What are the risk factors?
Cryptorchidism (6% of testicular tumors develop in patients with a history of cryptorchidism)
What is cryptorchidism?
Failure of the testicle to descend into the scrotum
Does orchiopexy as an adult remove the risk of testicular cancer?
What are the symptoms?
Most patients present with a painless lump, swelling, or firmness of the testicle; they often notice it after incidental trauma to the groin
What percentage of patients present with an acute hydrocele?
What percentage present with symptoms of metastatic disease (back pain, anorexia)?
What are the classifications?
Germ cell tumors (95%): Seminomatous ( 35%) Nonseminomatous ( 65%) Embryonal cell carcinoma Teratoma Mixed cell Choriocarcinoma Nongerminal (5%): Leydig cell Sertoli cell Gonadoblastoma
What is the major classification based on therapy?
Seminomatous and nonseminomatous tumors
What are the tumor markers for testicular tumors?
1. Beta-human chorionic gonadotropin ( -HCG)
2. Alpha-fetoprotein (AFP)
What are the tumor markers by tumor type?
B-HCG—c in choriocarcinoma (100%), embryonal carcinoma (50%), and rarely in pure seminomas (10%); nonseminomatous tumors (50%)
AFP—c in embryonal carcinoma and yolk sac tumors; nonseminomatous tumors (50%)
Define the difference between seminomatous and NONseminomatous germ cell testicular tumor markers
NONseminomatous common - 90% have a positive AFP and/or B-HCG
Seminomatous rare - only 10% are AFP positive
Which tumors almost never have an elevated AFP?
Choriocarcinoma and seminoma
In which tumor is -HCG almost always found elevated?
What other tumor markers may be elevated and useful for recurrence surveillance?
LDH, CEA, Human Chorionic Somatomammotropic (HCS), Gamma-Glutamyl Transpeptidase (GGT), PLacental Alkaline Phosphate (PLAP)
What are the steps in workup?
PE, scrotal U/S, check tumor markers, CXR, CT (chest/pelvis/abd)
What is the initial treatment for all testicular tumors?
Inguinal orchiectomy (removal of testicle through a groin incision)
What percentage of stage I seminomas are cured after treatment?
Which type is most radiosensitive?
Seminoma (Think: Seminoma Sensitive to radiation)
What is the major side effect of retroperitoneal lymph node dissection?
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