Testis Tumor Treatment

TREATMENT

      All testicular tumours need orchidectomy for diagnosis of cell type of tumour staging is achieved by the use of imaging technique

      -     stage I+II seminoma receive radiotherapy

      -     stage III receive in addition chemotherapy

      All non seminomas receive chemotherapy after orchidectomy. Tumour marker assay is used as guide to indicate tumour response to therapy.

Inguinal Orchidectomy Steps

-        An inguinal incision

-        Inguinal canal opened spermatic cord identified and clamped

-        The testis in the tunica is mobilized from parietal attachments and delivered in the inguinal wound

-        Open tunica vaginals and view the testis, if suspicious

-        Cord ligated and cut leaving a metal clip for further treatment

-        Testis sent for histology
Close wound

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Tumours testis choriocarcinoma symptoms markers

 Choriocarcinoma

      This accounts for only a small number of the germinal cell tumours, rapidly invading the venous system. Metastases are by blood and lymphatics, relatively unresponsive to chemotherapeutic measures.

10.4 Symptoms

      Pain in scrotum and heaviness are the commonest present ation and should be reported. A physical examination and ultrasound of the testis can reveal a testicular tumour. IVP and CT scan and bipedal lymphangiography can reveal the lymph gland enlargement of para-aortic glands

10.5 Tumour Markers

      In 90% of cases alpha feto-protien or human chorionic gonadotraphis can be detected in the serum and can help diagnosis. The other markers of help are in box.

      -     Placental lactogenic hormone

      -     Pregnancy specific antigens

      -     Placental alkaline phosphatase

      -     Carcinoembryonic antigen

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Testis Embryonal Carcinoma

Embryonal Carcinoma

      This tumour has more malignant potential and is seen in the younger age group and is probably the most common testicular tumour of child hood. It is less differentiated, thus invasion and metastases occur earlier.

Because of relatively rapid growth of the tumour haemorhage and necrosis are common. Metastases to the abdominal lymphatics occurs as an early event and may be seen at presentation. A cut section appearance seen above

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Testis Urethra Seminoma

 Seminoma

      This is the most common testicular malignant tumours and accounts for approximately 40% of lesions. It is uniform in gross and histologic appearance and is of slow growth with late invasion. Metastatics spread is via the testicular lymphatics to the iliac, aortic and renal hilar nodes. Metastatic seminoma is responsive to radiation therapy with a 5 year survival ranging upto 90%

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Testis Urethra Testicular tumours 1

TESTICULAR TUMOURS

      These are seen as 1% of all tumours in the male the majority are malignant tumours. The cause is unknown, however we do know that germ cell tumours occur in cryptorchids. No environmental or occupational factors have been identified.

      Malignant neoplasms of the testes may be of germinal or non-germinal cell origin. The non-germinal cell tumours known as Intestitial cell tumours (Leydig cell tumours) are rare tumours (5%) and may produce excessive androgenizing hormones causing verilism and precocious puberty in young males, in adults they present with impotence and gynaecomastia.

      The malignant germinal tumours of the testis are most common (90%) and originate from the totipotential cells of seminiferous tubules and occur most often between 20 to 35 years. Germinal testicular tumours are classified as seminoma, embryonal carcinomas and choriocarcinomas.

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Testis Urethra Mumps orchitis

 Mumps Orchitis

      It is a viral infection which produces sever local inflammatory reactions of the testis with accumulation of fluid within tumical vaginalis (hydrocele) this inflamation may cause loss of spermatagenis and lead to infertility.

      Treatment indicated is generally symptomatic, aspiration of the hydrocele is avoided. Mechanical support of the scrotum with an adhesive bridge, bed rest, analgesics and antipyretics are prescribed.

      Measles, influenza and similar infections may occasionally induce a secondary orchitis.

9.1 Tubercular orchitis is almost always secondary to tubercular epididymits, the primary focus is within the urinary tract generally, genitourinary tuberculosis is responsive to antitubercular medical management

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