GCNIS of the contralateral testis in a patient with testicular tumour is associated with an incidence of subsequent tumour development at 5 years out:
Answer C
There is a 10% risk of contralateral germ cell neoplasia in situ (GCNIS) with 50% developing into testicular cancer within 5-years. Those who are less than 40 years of ago with a testicular volume of less than 12cc have a 34% risk of GCNIS and should undergo contralateral biopsy (EAU guidelines). Two biopsies should be taken from the upper and lower pole. There is also an increased risk in those with undescended tests and subfertility.
Which of the following is associated with an increased incidence of carcinoma in situ of the testis (germ cell neoplasia in situ [GCNIS])?
Answer E
Risk factors for contralateral tumour or GCNIS include a history of previous testicular cancer, infertility, undescended testis, Klinefelter syndrome and family history of testicular cancer in a first-degree relative.
Which of the following is TRUE regarding alpha-fetoprotein (AFP)?
In addition to GCT of the testes raised AFP levels can be seen in patients with liver cancer or less commonly other cancers (for stomach, bowel, lung, breast and lymphoma). Mildly raised levels are also seen with chronic hepatitis or cirrhosis.
Which of the following is FALSE regarding human chorionic gonadotrophin (HCG)?
HCG may be raised in seminomatous and non-seminomatous testicular germ cell tumours as well as a hydatidiform moles and choriocarcinoma in women. Other tumours may lead to mildly raised HCG levels, and these include hepatic and pancreatic neuroendocrine tumours.
Which of the following is TRUE regarding oligospermia following successful treatment of a non-seminomatous testicular tumour?
Answer A
Weak or absent ejaculation is present in 50% of patients following modified retroperitoneal lymph node dissection. Oligospermia can persist for some time following treatment of testis cancer, even following orchidectomy and separate to the effects of chemotherapy, and hence, the need to sperm bank preoperatively.
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