What is the most common tumor in males age 15 to 30 years old

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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%