Testicular cancer. In a nutshell. It metastasizes early but is highly curable even in metastatic stage Tumor markers important in staging and follow-up. Epidemiology. occurs most often in men between the ages of 15 and 40, where is also the most frequent solid tumor
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-Normally, the testicles descend from inside the abdomen into the scrotum before birth. The risk of testicular cancer is increased in males with a testicle that does not move down into the scrotum
-Although most cancers develop in the undescended testicle, about 1 out of 4 cases occur in the normally descended testicle. Based on these observations it is probable that cryptorchidism doesn't actually cause testicular cancer but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.
-repetitive micro-trauma: bicycle or horseback riding
A) From the testicular parenchyma (90%): Germ cell tumors:
~50%/50% seminoma / non-seminomatous germ cell tumor
Non-seminomatous germ cell tumors are subdivided in:
-Yolk sac tumors
B) From the testicular stroma (10%): stromal tumors
-directly to para-aortic lymph nodes (because embryonic origin of testes is intra-abdominal)
-lung, liver, brain, bone
βHCG=human chorionic gonadotropin, beta subunit
Mnemonic: AFP-”fetal tissue growing in the testis” in case of non-seminoma
Radical orchiectomy. Note the inguinal approach and the use of the tourniquet.
Stage I (=no lymphadenopathy on CT and no distant metastases):
-one cycle of chemotherapy
-para-aortic (“prophylactic”) radiotherapy (low dose: 25-30 Gy)
Stage II (=positive lymphadenopathy)
Stage III (=distant metastases or highly elevated tumor markers)
-4-6 cycles of chemotherapy
-para-aortic lymph node dissection or chemotherapy (more complicated guidelines, too much for student level)
-every 2 months for year 1