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Testicular cancer: Difference between revisions
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<section begin="oncology" /><section begin="pathology" />'''Testicular cancer''' is most frequent in young males. It is the most common tumor in men in the 15 – 35 age group. There are three age peaks where testicular cancer is most common: | <section begin="urology" /><section begin="oncology" /><section begin="pathology" />'''Testicular cancer''' is most frequent in young males. It is the most common tumor in men in the 15 – 35 age group. There are three age peaks where testicular cancer is most common: | ||
* 15 – 35 years (the most common age group) | * 15 – 35 years (the most common age group) | ||
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== Pathology == | == Pathology == | ||
95% of testicular tumors originate from germ cells. The remaining 5% originate from the testicular stroma (which is derived from the sex cords), including Sertoli cells, Leydig cells or granulosa cells.<section end="oncology" /> | 95% of testicular tumors originate from germ cells. The remaining 5% originate from the testicular stroma (which is derived from the sex cords), including Sertoli cells, Leydig cells or granulosa cells.<section end="oncology" /><section end="urology" /> | ||
The classification can be visualised like this: | The classification can be visualised like this: | ||
[[File:Classification of testicular tumours.png|center|thumb|Classification of testicular tumours]] | [[File:Classification of testicular tumours.png|center|thumb|Classification of testicular tumours]] | ||
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|Usually DLBCL | |Usually DLBCL | ||
|} | |} | ||
<section begin="oncology" /> | <section begin="oncology" /><section begin="urology" /> | ||
== Clinical features == | == Clinical features == | ||
Testicular tumors usually present as incidentally discovered firm, painless masses on the testis. Unlike hydroceles, these masses cannot be transilluminated. In case of metastases there may be symptoms like cough, chest pain, or bone pain. | Testicular tumors usually present as incidentally discovered firm, painless masses on the testis. Unlike hydroceles, these masses cannot be transilluminated. In case of metastases there may be symptoms like cough, chest pain, or bone pain. | ||
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=== Stages === | === Stages === | ||
Limited disease refers to cancer which is limited to the testicles. Locally advanced disease is when there is involvement of the retroperitoneal lymph nodes, usually the para-aortic lymph nodes. Metastatic disease is when there is evidence of metastasis. | Limited disease refers to cancer which is limited to the testicles. Locally advanced disease is when there is involvement of the retroperitoneal lymph nodes, usually the para-aortic lymph nodes. Metastatic disease is when there is evidence of metastasis. | ||
<section end="urology" /><section begin="urology treatment" /> | |||
== Management == | == Management == | ||
All patients with suspected testicular cancer on ultrasound and physical examination should undergo surgical exploration. If surgery and intraoperative frozen histology sections cannot rule out malignancy, orchidectomy is performed. This allows for histological examination and complete staging and risk stratification. However, at no point should the urologic surgeon incise the tumour itself, for risk of seeding. A testicular prosthesis can be placed at the same time. If there is sign of retroperitoneal lymph node involvement, retroperitoneal lymph node dissection (RPLND) is indicated. | All patients with suspected testicular cancer on ultrasound and physical examination should undergo surgical exploration. If surgery and intraoperative frozen histology sections cannot rule out malignancy, orchidectomy is performed. This allows for histological examination and complete staging and risk stratification. However, at no point should the urologic surgeon incise the tumour itself, for risk of seeding. A testicular prosthesis can be placed at the same time. If there is sign of retroperitoneal lymph node involvement (most commonly the para-aortic lymph nodes), retroperitoneal lymph node dissection (RPLND) is indicated. | ||
<section end="pathology" /> | <section end="pathology" /> | ||
Localised disease with no high-risk features can usually be followed with active surveillance, but if there is intermediate or high-risk, adjuvant chemotherapy is recommended. In locally advanced disease, adjuvant radiotherapy or chemotherapy is indicated. For metastatic disease, adjuvant chemotherapy is indicated. | Localised disease with no high-risk features can usually be followed with active surveillance after surgery, but if there is intermediate or high-risk, adjuvant chemotherapy is recommended. In locally advanced disease, adjuvant radiotherapy or chemotherapy is indicated. For metastatic disease, adjuvant chemotherapy is indicated. | ||
=== Organ sparing surgery === | === Organ sparing surgery === | ||
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=== Radiotherapy === | === Radiotherapy === | ||
Seminomas are very radiosensitive, whereas non-seminomas are only moderately radiosensitive. For this reason, radiotherapy is mostly only used for seminomas. Radiotherapy is less and less used nowadays in favour of chemotherapy.<section end="oncology" /> | Seminomas are very radiosensitive, whereas non-seminomas are only moderately radiosensitive. For this reason, radiotherapy is mostly only used for seminomas. Radiotherapy is less and less used nowadays in favour of chemotherapy.<section end="oncology" /><section end="urology treatment" /> | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||