Surgery - Testicular Cancer
Definition cancer that starts in the testes. Risk Factors Risk of ectopic testis or testicular maldescent increased 40 times. Other factors include exposure to maternal oestrogen, family history, mumps, and contralateral testicular tumor. KIT gene mutations and chromosome 12 amplifications and deletions are among the genetic alterations discovered. Epidemiology Less prevalent, accounting for 1% of cancer cases in men, but more common in those aged 18 to 35, with a trimodal peak incidence in infancy, 25 to 40 years, and 60 years. Caucasians are more at risk than people of Asian or African descent. History A lump found in the testicles. Back pain from para-aortic lymphadenopathy, dyspnea, coughing, or hemoptysis from lung metastases are uncommon causes of back pain. Examination Hard testicular tumor that is painless; a secondary hydrocoele may be present. Lymphadenopathy (para-aortic, supraclavicular, etc.). Pleural effusion symptoms. Gynecomastia (caused by the production of HCG). Pathogenesis Seminomas (40 percent, peak in 30–40 years) and nonseminomatous germ-cell tumors (60 percent, peak in 20–30 years) are the two types of germ cell tumors. Embyronal cell carcinoma, choriocarcinoma, yolk sac tumors, and teratomas are examples of seminomas. Sertoli and Leydig cell tumors, as well as non-Hodgkin's lymphoma, are less common non-germ cell tumors. Seminomas are solid, light-colored, and well confined. Teratomas have a cystic appearance with parts that are necrotic and hemorrhagic. Micro: Seminomas are made up of sheets of homogeneous, densely packed cells that can range from anaplastic to well-differentiated spermatocytes. Teratomas are categorized according to the relative proportions and may comprise elements of embryonal and trophoblastic cell types with varied levels of development, as well as tissue from the yolk sac. Investigations Blood: FBC, Tumor Markers, U&Es, LFTs LDH, a-fetoprotein, and b-HCG. Pee: Pregnancy test: If the tumor generates b-HCG, the test is positive. Ultrasound of the testicles: To see the main tumor. CT scan for staging (abdomen, chest, and brain if disease is widespread). MRI for unclear lesions or FDG-PET for any remaining seminoma masses. Either Royal Marsden Hospital staging or TNM staging is employed. I - Excluded from testes. II: Lymphadenopathy of the abdomen; A: <2 cm, B: 2–5 cm, C: >5 cm. III: Nodal involvement above diaphragm; A, B, and C as mentioned previously. Extralymphatic metastases (Part IV). Management depends on the tumor's prognostic classification, stage, and histology. Before receiving chemotherapy or radiation therapy, patients should be given sperm banking. Seminoma: Excision of the afflicted testis with radical inguinal orchidectomy. Stage I: Adjuvant radiation (seminomas are very radiosensitive), chemotherapy (one carboplatin cycle), or observation are the available options. Radiotherapy, chemotherapy, or both in stages IIA and IIB. Multiagent chemotherapy (e.g., BEP; bleomycin, etoposide, cisplatin) for patients in Stage IIC and above. Radical inguinal orchidectomy in nonseminomatous GCT. Microscopic metastases to retroperitoneal lymph nodes will occur in 30% of cases in stage I. Options include primary retroperitoneal lymph node dissection (RPLND), chemotherapy, and surveillance. Stage II–IV: RPLND and/or multiagent platinum-based chemotherapy (seedling retroperitoneal lymph node masses that are less than 1 cm in size should be excised since they might harbor residual tumor material). Complications Of the illness: Metastases leading to neurological or pulmonary issues. Treatment: Surgery for hemorrhage, nerve damage, and wound infection. Chemotherapy side effects include bone marrow depression, nausea, and vomiting. While platinum compounds are neuro- and nephrotoxic, bleomycin can result in rashes, pneumonitis, or fibrosis. heart illness and subsequent cancers with long-term survival. Blood-borne spread to the lungs, brain, bone, and liver; local spread to the tunica vaginalis and down the spermatic cord; lymphatic spread to the para-aortic nodes, then to the mediastinal and supraclavicular nodes. Prognosis Good, with 90%–100% cure rates for early-stage illnesses. Seminomas have a high rate of cure. The prognosis for choriocarcinomas is the worst.
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