Testicular and penile tumours

31 Testicular and penile tumours





Questions



image What features of a testicular lump suggest malignancy?

image What are the tumour markers for testicular tumours?

image What are the risk factors for penile cancer?



Testicular cancer


Although rare, testicular cancer is the most common cancer of men aged 20–40 years. The incidence is increasing, but the overall 5-year survival is excellent (> 95%). Any lump within the testis should be treated as a tumour until proved otherwise.



Aetiology


There is a 10 times increased risk of cancer in an undescended testis; repositioning the testis at an early age does not alter the risk of cancer but the testis is now palpable. There is a clear genetic link: the relative risk in brothers is 8–10 and in father and son is 4. Virtually all cases show amplification of the chromosome 12q.



Clinical features


The presentation can vary (Fig. 3.31.1):


image painless, firm lump: there may also be a feeling of heaviness in the scrotum and a dull ache in the groin or abdomen; most present with a painless lump

image painful swollen testes: 10% present as an acutely swollen testis

image history of trauma: identifies a problem to the patient, who then presents with a lump

image back pain: caused by para-aortic lymph node metastases

image gynaecomastia: rare, caused by increased circulating hormones

image breathlessness from massive secondary deposits in the lungs

image bone pain from bony metastases.

image

Fig. 3.31.1 Presenting features of testicular tumours.



Pathology


Almost all (95%) testicular cancers are germ cell tumours, which spread first to the para-aortic lymph nodes and then to the lungs. They are classified as seminomas (40%) or non-seminoma germ cell tumours (NSGCT; 60%): including teratomas (32%; more common in the young), combined seminoma and teratoma, and other rare tumours (e.g. yolk cell carcinomas).



Investigations


Investigations provide diagnosis and staging (Table 3.31.1):


image ultrasound scan: of both testes at rapid access clinics
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Testicular and penile tumours

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