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Saturday, March 26, 2011

TESTICULAR TUMOURS

These are the most common form of malignant disease in men aged 25-34 years.
 The lesion may be a seminoma arising from spermatogonia, a teratoma from toti-potential germ cells or a combined tumour. These tumours occur in fit young men and should nowadays be regarded as curable. Early diagnosis and appropriate specialist treatment is essential.
Clinical features
A seminoma presents as a painless, often uniform, rapid enlargement of the testis. A teratoma causes more nodualr changes and may secrete chorionic gonadotrophin producing gynaecomastia. The tumour may be overlooked if obscured by a hydrocele or if the examination is inadequate. Some cases present with metastases.
Investigations
Spread to glands can be demonstrated by CT scanning, Screening for metastases should include chest X-ray and liver function tests.
Management
The testis should be removed using the inguinal approach. Histology gives some idea of prognosis. A seminoma confined to the testicle or with metastases below the diaphragm is treated by radiotherapy to which it is very sensitive. More widespread seminoma requires chemotherapy and this is the treatment of choice for teratoma. The usual agents are cisplatinum and bleomycin. The treatment is a considerable or deal and should be carried out in a specialised department. Circulating tumour markers are help in assessing response to treatment and for monitoring patients in remission.

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