1.
Einhorn, Lawrence H. (2024). In Goldman-Cecil Medicine (pp. 1382). DOI: 10.1016/B978-0-323-93038-3.00185-4
Testicular cancer has an annual incidence of about 8700 cases per year in the United States and accounts for only 1% of all male malignancies.Nevertheless, it is the most common carcinoma in men ages 15 to 35 years.In the United States, testicular cancer is four to five times more common in White men compared with men of other ethnicities,but incidence rates are rising in Asian/Pacific Islander and Hispanic men.Men who have cryptorchidism have a 10- to 40-fold increased risk for the development of testicular cancer in the undescended testis, but even the normally descended testis in these men has a higher risk for malignancy. Testicular cancer is associated with drinking alcohol, overweight and obesity, and elevated blood lipid levels.
Terminology
Pathological classification based on cell type (WHO 2022)
Germ cell tumors
Approximately 95% of germ cell tumors arise in the testicles
5% of germ cell tumors develop in extragonadal sites, usually in the midline of the body (eg, retroperitoneum, mediastinum, brain)
Comprise 95% of testicular malignant tumors; testicular cancer and germ cell tumor are typically synonymous
Categorized as:
Germ cell tumors derived from germ cell neoplasia-in-situ
Seminoma
55% to 60% of germ cell tumors are pure seminomas, and 80% to 85% are stage I at diagnosis
Most common testicular cancer in adults and in patients with cryptorchidism
Non-seminomatous germ cell tumors
40% to 45% of germ cell tumors are non-seminomas
More clinically aggressive with often faster growth rate
Multiple cell types, including:
Embryonal carcinoma
Choriocarcinoma
Yolk sac tumor, postpubertal type
Teratoma, postpubertal type
Placental site trophoblastic tumor
Epithelioid trophoblastic tumor
Cystic trophoblastic tumor
Teratoma with somatic-type malignancy
Mixed germ cell tumors
Germ cell tumors of unknown type
Germ cell tumors unrelated to germ cell neoplasia-in-situ
Spermatocytic tumor
Teratoma, prepubertal type
Yolk sac tumor, prepubertal type
Testicular neuroendocrine tumor, prepubertal type
Mixed teratoma and yolk sac tumor, prepubertal type
Non-germ cell tumors (rare)
Sex-cord stromal tumors
Tumors of the testicular adnexa
TNM staging
American Joint Committee on Cancer staging system, 8th edition (2018)
Primary tumor (T)
Clinical (cT)
cTX: primary tumor cannot be assessed
Synopsis
Testicular cancer is a relatively rare malignancy, typically occurring in younger males; with proper treatment, disease is highly curable, even if metastatic
Germ cell tumors comprise 95% of malignant testicular tumors
Broadly categorized as seminomas and nonseminomas
Painless testicular mass is most common presentation; approximately 20% of patients present with pain
Diagnosis is suspected based on history, physical examination, and transscrotal ultrasonogram findings
More than 95% of intratesticular masses are malignant
Radical inguinal orchiectomy (removal of testis and spermatic cord) is generally performed to make final diagnosis and provide staging information
Serum tumor markers (α-fetoprotein, β-hCG, and lactate dehydrogenase) are informative for diagnosis, staging, and prognosis
Management of testicular cancer consists of orchiectomy and may include chemotherapy, radiation therapy, or other surgery, depending on stage and tumor type
Most commonly presents at early stage and is highly curable with radical orchiectomy
More advanced stages are curable with multimodality treatment approach
Main complications include chemotherapy-related toxicities, infertility, secondary malignancies, cardiovascular disease, hypogonadism, and peripheral neuropathy
5-year survival rate for testicular cancer is 94.9%; for localized cancer confined to primary site (majority diagnosed at this stage), 5-year survival rate is 99%
Long-term survival for males with metastatic germ cell tumor is 80% to 90%
