Download - Case Discussion - Testicular Tumors
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Testicular Tumors
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Testicular cancer is the
most common cancer in
younger men ages between
1545 with over 2,300cases diagnosed per year
98% cure rates are possible
if found at an early stage
Even when testicular cancer
has spread to other areas of
the body, cure can still be
achieve
St. Bartholomews Hospital, Londonwww.orchid-cancer.org.uk
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Number of New Cases and Deaths per
100,000 from 1992-2011
Estimated New
Cases in 20148,820
% of All New
Cancer Cases0.5%
National Cancer Institute: Surveillance, Epidemiology, and EndResults (SEER) Program
Estimated
Deaths in 2014380
% of all cancer
deaths0.1%
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Relative Survival of 5yrs or more after
Diagnosis of Testicular Cancer
National Cancer Institute: Surveillance, Epidemiology, and End Results(SEER) Program
Percent Surviving
5 Years
95.3 %
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Percent of Cases & 5-Year Relative
Survival by Stage at Diagnosis: Testis
Cancer
National Cancer Institute: Surveillance, Epidemiology, and End Results(SEER) Program
Localized (68%)
Confined to
Primary Site
Regional (18%)
Spread to Regional
Lymph Nodes
Distant (12%)
Cancer Has
Metastasized
Unknown (1%)
Unstaged
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Compared to other cancers, testis
cancer is rareCommon Types ofCancer
Estimated NewCases 2014
EstimatedDeaths 2014
Prostate Cancer 233,000 29,480
Breast Cancer
(Female)232,670 40,000
Lung and Bronchus
Cancer224,210 159,260
Colon and RectumCancer
136,830 50,310
Melanoma of the Skin 76,100 9,710
Bladder Cancer 74,690 15,580
Non-Hodgkin
Lymphoma70,800 18,990
Kidney and RenalPelvis Cancer
63,920 13,860
Thyroid Cancer 62,980 1,890
Endometrial Cancer 52,630 8,590
- - -
Testis Cancer 8,820 380
National Cancer Institute: Surveillance, Epidemiology, andEnd Results (SEER) Program
Testis cancer
represents 0.5% of all
new cancer cases
0.5%
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Background: Incidence
GCTs are the most common solid tumors in
men between the ages of 15 and 35 years.
In a man aged 50 or older, a solid testicular
mass should be regarded as lymphoma until
proven otherwise.
Devita, Hellman & Rosenberg's Cancer: Principles & Practice ofOncology, 8th Edition
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Percent of New Cases by Age Group:
Testis Cancer
National Cancer Institute: Surveillance, Epidemiology, and EndResults (SEER) Program
Median Age
At Diagnosis
33
Testis cancer is
most frequently
diagnosed among
men aged 20-34.
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Percent of Deaths by Age Group:
Testis Cancer
National Cancer Institute: Surveillance, Epidemiology, and End
Results (SEER) Program
Median Age
At Death
41
The percent of
testis cancer
deaths is highest
among men aged
20-34.
f
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Number of New Cases per 100,000
Persons by Race/Ethnicity: Testis
Cancer
National Cancer Institute: Surveillance, Epidemiology, and End
Results (SEER) Program
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Epidemiology:
Familial clustering has been observed,particularly among siblings.
Studies have failed to identify an association
between vasectomy, diethylstilbestrol exposure,trauma, or viral infection, and GCT.
More recently, testicular cancer has beenreported in men infected with HIV; however, few
data support a higher incidence of GCT in HIV-infected individuals, and the results of treatmentare similar.
Devita, Hellman & Rosenberg's Cancer: Principles & Practice ofOncology, 8th Edition
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Epidemiology: Philippines
Cases of testicular and prostate cancers, which
are the leading cause of cancer deaths in men
20-35yo and second most common cancer in
men are increasingly becoming a cause forconcern
14thCongress of the Republic of the Philippineshttp://www.senate.gov.ph/
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Epidemiology: Philippines
In the study M.T.M. Redaniel, A.V. Laudico,
et.al., Cancer in the Philippines
From a total of 27, 130 male subjects from Metro
Manila & Rizal Provinces, 248 (0.9%) had testicular
tumor
Vol. IV Part 1Cancer incidence 1998-2002
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Possible Risk Factors:
Cryptorchidism
Carcinoma in situ
Brother/father w/
testicular CA
Previous history of
testicular CA
Sedentary lifestyle
Repeated trauma
(rather than
inevitable knocks)
Smoking marijuana Men with HIV are up
to twice as likely to
develop testicular
CASt. Bartholomews Hospital, London
www.orchid-cancer.org.uk
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Cryptorchidism
Associated with several-fold higher risk of GCT
Abdominal cryptorchid testis are at higher risk
than inguinal cryptorchid testis
Orchidopexy should be performed before
puberty
Early orchidopexy reduces the risk of GCT and
improves the ability to save the testis
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
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Cryptorchidism
Associated with 10% of testicular GCTs
The most important risk factor
Part of a spectrum of d/o known as testiculardysgenesis syndrome(TDS):
Cryptorchidism
Hypospadias
Poor sperm quality
Kumar, Abbas, Fausto, Aster Robbins & CotranPathologic Basis of Disease8thed
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Cryptorchidism
In the cohort study by Pettersson et.al., onmen who underwent orchiopexy forundescended testis at Sweden between 1964-
1999, they determined the age at treatmentfor undescended testis and the risk oftesticular cancer
They concluded that, treatment forundescended testis before puberty decreasesthe risk of testicular cancer
Age at surgery for undescended testis and risk of testicular cancer
http://www.ncbi.nlm.nih.gov/pubmed
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Cryptorchidism
In the systematic review & meta-analysis by
Walsh TJ, et.al., determines whether
orchiopexy affects the natural history of
testicular cancer development
They concluded that, early surgical
intervention is indicated in children with
cryptorchidism
Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular
cancer 2007http://www.ncbi.nlm.nih.gov/pubmed
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Possible Risk Factors:
Cryptorchidism
Carcinoma in situ
Brother/father w/
testicular CA
Previous history of
testicular CA
Sedentary lifestyle
Repeated trauma
(rather than
inevitable knocks)
Smoking marijuana Men with HIV are up
to twice as likely to
develop testicular
CASt. Bartholomews Hospital, London
www.orchid-cancer.org.uk
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Genetics
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
i12p
Pathognomonic of GCT
of all histologic types
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Histologic Types
St. Bartholomews Hospital, London
www.orchid-cancer.org.uk
Most are
aggressivecancers
Generally,
benign
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Clinical Presentation
Painless testicular
mass
Testicular
discomfort/swelling
Backpain
Dyspnea Gynecomastia
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
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Painless testicular mass Swelling(orchitis/epididymitis)
Trial of antibiotics
Ultrasound Persistence
(+) Mass Radical inguinal orchiectomy
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
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(+) Mass Radical inguinal orchiectomy
CXR, CT of abd & pelvis
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
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Staging
Includes determination serum
AFP
hCG
LDH
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012
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Staging
St. Bartholomews Hospital, London
www.orchid-cancer.org.uk
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Staging
St. Bartholomews Hospital, London
www.orchid-cancer.org.uk
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St. Bartholomews Hospital, London
www.orchid-cancer.org.uk
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Pathology
Nonseminomatous GCTs
Choriocarcinoma
Consisting of cyto- & syncytiotrophoblast
Malignant trophoblastic differentiation
Assoc w/ hCG secretion
Highly malignant
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Choriocarcinoma
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Yolk-sac tumor
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Embryonal Carcinoma
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Pathology
Nonseminomatous GCTs
Teratoma
Composed of somatic cell types derived from 2 or more
germ layers Occur at any age
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Teratoma
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Pathology
Seminomatous GCTs
Seminoma
50% of all GCTs
Peak at 30s, never occurred in infants
More indolent clinical course
70% pt presents w/ stage I disease
Lung & visceral metastasis are rare
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Seminoma
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Treatment
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Longo, Fauci, et.al. Harrisons Principles of Internal Medicine18thed, 2012