🎧MSRA Deep Dive:Testicular Cancer – High-Yield, Concise, and Clinically Relevant

Let’s cut throughthe noise—this is your rapid yet comprehensive MSRA revision tool on testicular cancer, one of the most commonmalignancies in young men and a frequent exam topic. We’ll walk you througheverything you need: risk factors, presentation, investigations, management,and complications.

🧠Key Learning Points

📌Definition

• Testicular cancer = malignancy of the germ cells in one or both testicles.
• Most cases are seminomas or non-seminomatous germ cell tumours (NSGCTs).
• Peak age: 15–49 years. Highly treatable, especially if caught early.

📌Risk Factors

• Cryptorchidism (undescended testicle)
• Family or personal history
• Klinefelter syndrome
• Infertility (×3 risk), HIV, mumps orchitis
• TGCT1 gene, abnormal chromosome 12
  ❗️ Not linked: trauma, vasectomy, microlithiasis

📌Symptoms & Signs

• Painless testicular lump (classic finding)
• Dull ache, heaviness, or enlargement
• Gynaecomastia (β-HCG secretion)
• Back pain = possible metastasis
• On exam: firm, non-tender lump, usually separate from epididymis
• ⚠️ Rule out torsion, infection, benign lumps like hydroceles or spermatoceles

📌Investigations

🔍First-line: Scrotal ultrasound

🧪Tumour markers:

• AFP – raised in NSGCTs, not seminomas
• β-HCG – raised in NSGCTs and some seminomas
• LDH – nonspecific but useful for prognosis
  📸 CT chest/abdomen/pelvis – staging
  🩺 Important: Normal markers DO NOT rule out cancer

📌Management

• Orchidectomy via inguinal approach = first step for all
• Seminoma:
• • Stage I: surveillance ± single-agent chemo or radiotherapy
  • Stage II+: chemo ± radiotherapy
• NSGCTs:
• • Stage II+: BEP chemotherapy (bleomycin, etoposide, cisplatin)
  • Post-chemo residual mass? → Surgical resection (if non-seminoma)
• Fertility: Offer sperm banking before treatment
• Prosthesis offered post-op for cosmetic reasons
• 🚨 2WW referral required for all suspected cases

📌Prognosis

• Excellent if caught early (>95% survival Stage I)
• Slightly worse for NSGCTs vs seminomas
• Late relapses rare but possible
• Monitoring: Follow-up 5–10 years
  ⚠️ Risk of infertility, hypogonadism, second cancers, CVD

📌Complications

• Metastases (lungs, retroperitoneum, brain)
• Infertility, hypogonadism, recurrence
• Long-term: Chemo side effects (neuropathy, ototoxicity), cardiovascular risk
• Psychosocial impact (anxiety, financial stress, sexual function)

🧠Mnemonics & Tips

• Think: “Young man + painless lump = testicular cancer until proven otherwise”
• Markers: “AFP → yolk sac; β-HCG → choriocarcinoma/seminoma”
• Key ages: Teratomas ~25y, Seminomas ~35y

📎Useful MSRA Links –Testicular Cancer Revision

📝 Revision Notes:

https://www.passthemsra.com/topic/testicular-cancer-revision-notes/

🧠 Flashcards:

https://www.passthemsra.com/topic/testicular-cancer-flashcards/

💬 Accordion Q&A:

https://www.passthemsra.com/topic/testicular-cancer-accordion-qa-notes/

🚀 Rapid Quiz:

https://www.passthemsra.com/topic/testicular-cancer-rapid-quiz/

🩺 MSRA Surgery Course:

https://www.passthemsra.com/courses/surgery-for-the-msra/

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