case discussion - testicular tumors

8/11/2019 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



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Genetics


i12p

Pathognomonic of GCT

of all histologic types


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Histologic Types

St. Bartholomews Hospital, London


Most are

aggressivecancers

Generally,

benign


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Clinical Presentation

Painless testicular

mass

Testicular

discomfort/swelling

Backpain

Dyspnea Gynecomastia



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Painless testicular mass Swelling(orchitis/epididymitis)

Trial of antibiotics

Ultrasound Persistence

(+) Mass Radical inguinal orchiectomy



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(+) Mass Radical inguinal orchiectomy

CXR, CT of abd & pelvis



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Staging

Includes determination serum

AFP

hCG

LDH



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Staging




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Staging




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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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case discussion - testicular tumors

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