3Testicular Tumors-WHO Classification Lymphoid and Haematopoietic tumorsLymphoma, plasmacytoma, leukaemiaParatesticular TumorsAdenomatoid tumorMesotheliomaAdenomaCarcinomaDesmoplastic small round cell tumorsSoft tissue tumorsSecondary tumorsTumor like lesionsGerm Cell TumorsCISSeminomaClassic, Anaplastic , spermatocyticNSGCTEmbryonalYolk SacChoriocarcinomaTeratomaSex Cord/gonadal stromal tumors
4Carcinoma in-situHigh Risk: Cryptorchidism (3%), Infertile men (1%), Extragonadal GCT (40%).Thought to be the precursor of GCT.Found in most testis with GCT.Found in 5% of contralateral testis.Will all eventually develop GCT.
5Germ Cell tumors-Seminoma 35-70% of GCTAged y.oCan contain synsytiotrophoblastsNo AFP elevation,15% have HCG elevation.
6Germ Cell Tumors- Non Seminoma Approx 40% GCTCombination of :EmbryonalYolk SacChriocarcinomaTeratoma-benign, malignant transformation.T
7Gonadal Stromal Tumors Leydig Cell TumorFrom the stromal cells of the testis.Approx 10% metastasise.Leydig Cell Tumors3% of testicular tumors.Adults 30% feminisation.Sertoli Cell Tumors2% of adult tumorsMore benign.Sertoli Cell Tumor
8Testis cancer-Epidemiology Most frequent malignancy of white males agedRare in Asian and African populations.Frequency Increasing. ?WhyEncourage testicular self exam- no evidence of clear benefit.
9Predisposing Conditions Family HistoryBrothers increase risk much more than fathers or other 1st degree relativesUndescended TesticlesOther causes of testicular atrophyMaternal Estrogen exposure?
10Testis Cancer Presentation Painless swelling of the testis.Painful testis (10%)Tender breasts.Back pain, abdominal massCough, haemoptysis, SOBNeck massOften Delayed Presentation Because of Embarrassment.
11Testicular Tumor-Investigation and Diagnosis. Clinical suspicion.Tumor markersAFPHCGLDHUltrasoundOrchidectomy
15NSGCT- Stage II Disease in RP OptionsChemotherapyRPLND
16NSGCT- Stage III Disease in chest or other viscera 85% survivalTreatment :Chemotherapy
17Seminoma- Stage I Confined to the Testicle 20% chance of micrometastasis to RPOptions:XRT to RPSurveillanceChemotherapy (single cycle)
18Seminoma-Stage II Disease in the RP Options for treatmentChemotherapyXRT if mass <5cm
19Seminoma- Stage III Disease in chest or other viscera OptionsChemotherapy
20Which Chemotherapy? IGCCCG classification. Good Risk Tesicular or RP primary, nomets other then lungs, low tumour markers.GET BEPx3 or EPx4Intermediate and Poor RiskBEP X4
21Chemotherapy Complications BleomycinLung and Vessel fibrosis.EtoposideLate secondary malignanciesCisplatinRenal toxicityNeuro toxicityAllHaemopoetic
22Fertility Reduced fertility even before orchidectomy. Orchidectomy will possibly reduce sperm count a little.Chemotherapy:Reduced fertility for approx 2 yearsXRT (dogleg) will reduce fertility.Solution:Sperm banking
23The Residual Mass after Chemotherapy Can occur in:RPLUNGsLiverOther sites.
24What is it made off? NSGCT Necrosis/ fibrosis= 50%Teratoma = 45%Viable cancer = 5%Can you predict?Degree of shrinkageTeratoma in primarySize of the mass
25What is it made of? Seminoma Depends on size.<3cm only 2/74 had viable cancer>3cm 25% had viable cancerPET scan is useful for seminoma masses.
26Retroperitoneal Lymphnode Dissection (RPLND) What is it done for?Removal of all retroperitoneal nodes after chemo (including and mass).Removal of retroperitoneal tumour when still growing and have run out of chemotherapyOccasional for other cancer types eg. Renal cancer or TCC of the bladder.