M & M “it’s probably in your head”. Kommerien Daling 2-14-08. CASE. 11/19/07: Acute visit. 30 yo WM, C/O tingling Rt leg on 11/14. Resolved while driving to FL for wedding. Next day tingling Lt leg, scrotum, Rt arm, Lt buttock. CHART REVIEW.
M & M“it’s probably in your head”
Kommerien Daling 2-14-08
3) Chronic prostatis, controlled.
S/ Anxiety. Mass on testicle. Increasing low grade pain after ejaculation.
O/ Lt testicle w/ mass, prominent epididymis, minimal pain. Some TTP of prostate, but not exquisite. UA-ve.
A/P 1) Acute prostatitis, Gc/chlam obtained.
Rx Doxy. 2) Anxiety. Restart Lexapro
(quit in 3/06).
2.1 x 1.4 x 1.5 cm
B-12 borderline low -> PO vit B12.
“it’s probably in your head”
Risk factors for testis cancer
Duplication oramplification of the short arm of chromosome 12 (12p)is seenin almost all cases of testis cancer, implying that a key geneis present in this area.
Clinical manifestations of testis cancer from metastaticdisease*Systemic symptoms: anorexia, malaise, weight loss * Coughor shortness of breath due to pulmonary metastases * Neck massdue to lymph node metastases * Lower back pain from bulky retroperitonealdisease * Lower extremity swelling due to iliac or caval obstructionorthrombosis (unilateral or bilateral) * Nausea, vomiting orgastrointestinal haemorrhage fromretroduodenal metastases * Bonypain* Central or peripheral nervous system symptoms from cerebral,spinal cord or peripheral nerve root involvement
LDH: elevated in 50%, not specific to type, proportionate to tumor size
pTis, N0, M0, S0
pT1-4, N0, M0, SX
pT1, N0, M0, S0
pT2, N0, M0, S0pT3, N0, M0, S0pT4, N0, M0, S0
Any pT/Tx, N0, M0, S1-3
Any pT/Tx, N1-3, M0, SX
Any pT/Tx, N1, M0, S0Any pT/Tx, N1, M0, S1
Any pT/Tx, N2, M0, S0Any pT/Tx, N2, M0, S1
Any pT/Tx, N3, M0, S0Any pT/Tx, N3, M0, S1
Any pT/Tx, Any N, M1, SX
Any pT/Tx, Any N, M1a, S0Any pT/Tx, Any N, M1a, S1
Any pT/Tx, N1-3, M0, S2Any pT/Tx, Any N, M1a, S2
Any pT/Tx, N1-3, M0, S3Any pT/Tx, Any N, M1a, S3Any pT/Tx, Any N, M1b, Any S
70-80% cured with orchiectomy alone.
disease-specific survival in the range of 98%
to100% regardless of which approach
RPLND for NS
RXT for seminoma
9 wk BEP or 12wk EP
12 wk BEP.
Clinical Stage I Seminoma - Treated with Adjuvant Radiation(Nichols Protocol)
every 2 months
every 4 months
every 6 months
once a year
Clinical Stage I Seminoma - Treated with Surveillance only (Nichols Protocol)
every 2 monthsAbdominal CT scan done every 3 months
every 2 monthsAbdominal CT scan done every 4 months
every 6 monthsAbdominal CT scan done every 6 months
Suspect and consider biopsy in:
Bilateral or contralateral: local RXT & F/U bx.
The USPSTF recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males.
No evidence that screening with clinical examination or testicular self-examination is effective in reducing mortality from testicular cancer. Even in the absence of screening, the current treatment interventions provide very favorable health outcomes. Given the low prevalence of testicular cancer, limited accuracy of screening tests, and no evidence for the incremental benefits of screening, the USPSTF concluded that the harms of screening exceed any potential benefits.
Drawing 1. Cup your scrotum with one hand to see if it feels normal.
Drawing 2. Feel for any lumps in or on the side of the testicle.
Drawing 3. Feel along the epididymis for swelling.