Testicular cancer

relatively rare and accounts for 1-1.5% of male cancers

it is rare before puberty but is the most common tumour in young and middle aged men (usually in males between the ages of 15-49)

1. Testicular tumours can be divided into:
   1. germ cell tumours (GCTs)
      1. 90-95% of testicular tumours
      2. e.g. – Seminoma, Spermatocytic seminoma
      3. considered a curable cancer owing to the >95% cure rate in all patients
      4. 90% cure rate in patients with metastatic disease
   2. lymphomas
      1. about 4% of testicular tumours
      2. almost always found in men aged over 50 years
      3. generally treated as a different disease entity from GCTs
   3. cord stromal tumours
      1.  e.g. – Leydig cell tumour, Sertoli cell tumour
      2. uncommon and usually benign
   4. rare tumours
      1. arising in paratesticular structures include rhabdomyosarcomas in children and liposarcomas in older men
2. Risk factors
   1. Cryptorchidism – risk for both the descended and undescended
   2. Subfertility
   3. Caucasian
   4. Family history
   5. Previous contralateral tumour
   6. HIV
   7. Down syndrome
3. Clinical
   1. painless, solid, unilateral mass in the scrotum (majority of cases)
      1. scrotal pain (20% of cases)
   2. enlarged testicle, a decrease in testicular size may also occur
   3. hydrocoele
   4. metastases:
      1. metastatic growths in lung resulting in cough, pain or haemoptysis
      2. abdominal mass and backache due to enlarged para-aortic lymph nodes
      3. cervical lymphadenopathy
   5. backache (10%)
   6. gynaecomastia (7%)
   7. dragging sensation in the scrotum
   8. incidental recent trauma (It is not thought that the trauma causes the cancer, but rather that it brings an existing tumour to the attention of the patient and physician)
4. Investigations
   1. USS
   2. AFP, BHCG, LDH
   3. CT C/A/P
   4. Serum testosterone
   5. LH/FSH – assess testicular failure
   6. Testicular biopsy, radical orchidectomy
   7. CT C/A/P, CXR
   8. Consider sperm banking
5. Treatment
   1. Radical orchidectomy
   2. Chemotherapy
   3. Consider psych referral
6. Follow up – monitor BHCG AFP, LDH