3 Testicular 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
4 Carcinoma 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.
5 Germ Cell tumors-Seminoma 35-70% of GCTAged y.oCan contain synsytiotrophoblastsNo AFP elevation,15% have HCG elevation.
6 Germ Cell Tumors- Non Seminoma Approx 40% GCTCombination of :EmbryonalYolk SacChriocarcinomaTeratoma-benign, malignant transformation.T
7 Gonadal 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
8 Testis 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.
9 Predisposing Conditions Family HistoryBrothers increase risk much more than fathers or other 1st degree relativesUndescended TesticlesOther causes of testicular atrophyMaternal Estrogen exposure?
10 Testis Cancer Presentation Painless swelling of the testis.Painful testis (10%)Tender breasts.Back pain, abdominal massCough, haemoptysis, SOBNeck massOften Delayed Presentation Because of Embarrassment.
11 Testicular Tumor-Investigation and Diagnosis. Clinical suspicion.Tumor markersAFPHCGLDHUltrasoundOrchidectomy
22 Fertility 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
23 The Residual Mass after Chemotherapy Can occur in:RPLUNGsLiverOther sites.
24 What is it made off? NSGCT Necrosis/ fibrosis= 50%Teratoma = 45%Viable cancer = 5%Can you predict?Degree of shrinkageTeratoma in primarySize of the mass
25 What 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.
26 Retroperitoneal 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.