Testicular cancer for undergraduate level

1. Testicular Tumors
Mohammed Fathy Bayomy, MSc, MD
Lecturer of Clinical Oncology
Clinical Oncology & Nuclear Medicine Department
Faculty of Medicine
Zagazig University

2. The commonest cancer in men
aged 20–40 years.
1% of all cancers in men

3. Family history of
testicular cancerCryptorchidism
Atrophic
testis
History of
torsion
Infertility
Klinefelter’s
syndrome
Down’s
syndrome
Testicular feminization
syndromes (AISs)

4. Germ Cell Tumours (GCT) (95%) Other tumors
Lymphomas
Melanoma
Seminoma
Sex cord-stromal
Testicular intratubular germ cell neoplasia carcinoma
(TIGCN) = Germ Cell Neoplasia In Situ (GCNIS)
Non-seminoma
Embryonal
Rhabdomyosarcomas
Classic Spermatic Yolk sac carcinoma
Teratoma
Embryonal carcinoma
Choriocarcinoma
Sertoli cell tumors
Leydig cell tumors
Granulosa cell tumors
Mesothelioma of
tunica vaginalis

5. Painless solid mass in scrotum
Painful enlargement of testis
Local Metastatic
Epididymo-orchitis
Infertility
Lymph node spread
Back pain
Thoracic symptoms
Paraneoplastic
Gynecomastia

6. Serum
tumour
markers
Testicular ultrasound
CT Chest, Abdomen, Pelvis
Pathological
confirmation
Testicular biopsy is
contraindicated
Genetic
analysis
PET scan

7. Stage I Stage IIIStage II
IIA
IIB IIC
IA
IB
IS
IIIA
S0
S0
S0-1
S1-3
S0-1
S2
IIIB
S3 IIIC

8. StageI
Surgery
StageIIA,IIBStageIIC
Radicaltransinguinalorchiectomy
Active
Surveillance
Seminoma
AdjuvantRadiotherapy
20-24Gyto
paraaortic
nodes
30-36Gytoparaaortic
andipsilateralpelvic
nodes
AdjuvantChemotherapy
One cycle of
carboplatin at
AUC of 7
Three cycles
BEP (Bleomycin,
Etoposide,
Cisplatin) or
four
cycles of EP

9. Surgery
Radical transinguinal
orchiectomy
Non-Seminoma
Stage I & II
Retroperitoneal
lymph node
dissection (RPLND)
Active Surveillance
Adjuvant
Chemotherapy
Three cycles BEP
or
Four cycles of EP
Stage III (Seminoma or Non-Seminoma)
Chemotherapy
Four cycles of BEP.Three cycles of BEP.
Surgery
Radical transinguinal
orchiectomy
Resection of residual
disease
Intermediate-PoorGood Risk
Post-excision Chemotherapy
Two cycles of EP
Relapsed
Germ Cell
Tumor
Chemotherapy
Platinum based combination
Non-platinum-based combination
TIPVIP VeIP
Taxol, Gemcitabine