Professional Documents
Culture Documents
CANCERS
Dr. Ayush
Garg
Overview
Cancers of testis are relatively rare cancer accounting for approx. 1 % cancer
in males.
However it is important in field of oncology as it represents a highly
curable neoplasm & the incidence is focused on young patients at their
peak of productivity
Anatomy
• The testis is the male gonad.
• It is homologous with the ovary in female.
• It lies obliquely within the scrotum suspended by
the spermatic cord
• The left testis is slightly lower than the right
• Shape: Oval
• Size:3.75 cm long, 2.5 cm broad, 1.8 cm thick
• Weight: about 10-15 gm.
• Has 2poles , 2surface, 2 borders
Coverings of
testis
Skin
DARTOS Muscle
External Spermatic
Fascia
Cremastric Muscle
Internal Spermatic Fascia
Tunica Vaginalis
Tunica Albuginea
Blood Supply
Areterial supply
• The testicular artery branch of abdominal aorta .
• The testis has collateral blood supply from
1. the cremasteric artery
2. artery to the ductus deferens
Venous drainage
• The veins emerge from the back of the testis, and receive
tributaries from the epididymis;
• they unite and form convoluted plexus, called the
pampiniform plexus.
• plexus to form a single vein, which opens, on the right side,
into the inferior vena cava ,on the left side into the left
renal vein
Lymphatic Drainage
On the left:
Preaortic and para-aortic nodes and thence to the interaortocaval
Non seminomatous
germ-cell tumors 4: others 5%
60% lymphoma
Embryonal rabdomyosarcoma
carcinoma 20- melanoma
25%
Teratoma 25-
35%
Yolk sac
Seminoma
⚫The commonest variety of testicular tumour
⚫Adults are the usual target (4th and 5th decade); never seen in infancy
⚫Right > Left Testis
⚫Starts in the mediastinum: compresses the surrounding structure.
⚫Patients present with painless testicular mass
⚫30 % have metastases at presentation, but only 3% have symptoms related
to metastases
Seminoma
• Serum alpha fetoprotein is normal
• Beta HCG is elevated in 30% of patients with Seminoma
• Classification
a) classical
b) Anaplastic
c) Spermatocytic
Spread
1. Direct Spread:
This spread occurs by invasion.
Whole of testis in involved and restricted
Tunica albuginea is rarely penetrated
May be crossed by “blunder biopsy”
Scrotal skin involvement
Fungation on the anterior aspect
Spread to spermatic cord and epidedymis
may occur : points towards bad
prognosis
Spread
2. Lymphatic spread:
The mean dose (Dmean) and dose delivered to 50% of the volume (D50%) of
the kidneys, liver, and bowel are lower with CT-based AP-PA 3D-CRT than
IMRT.
As a result, the risk of second cancers arising in the kidneys, liver, or bowel
may be lower with 3D-CRT than IMRT, and IMRT is not recommended.
3D Planning
Shielding
Contra-lateral testis is shielded with a lead clamshell device.
Dose
20 Gy in 10# to para-aortic ±
pelivic lymph node by ap-pa
field
10 Gy in 5 #
Complications : Radiotherapy
80–100 cGy causes total azospermia with recovery 1–2 year later for some patients
Regimens
Single-agent one cycle of carboplatin become an alternative for stage I
seminoma
Regimens including BEP x 3 cycles, EP x 4 cycles, PVB, and VIP for stages II–IV
diseases
“I always had the size difference there, but I didn’t
know…I would’ve still been waiting if it hadn’t started
hurting, it just got so painful I couldn’t sit on my bike
anymore.”
-Lance Armstrong