Testicular Cancer

Testicular cancer is the most common malignancy in young adults

Which of the following statement about testicular cancer is NOT correct?

• Treatment depends on tumour types: seminoma vs non-seminomaa
• 5-year survival rate in England is higher than 95%
• More than 50% of cases occur in men aged 60 or above
• The cells of seminoma have a 'fried egg' appearance

32-year-old man presents with the feeling of a mass in the left testis. On examination, a painless, round and firm mass is palpated in the left testes with a size of 1.5 cm by 1 cm. The mass does not transilluminate with light.

29-year-old man presents with palpitations, heat intolerance, increased sweating, increased bowel movement and unintentional weight loss. On examination, a thyroid gland is normal. A hard nodule in the right testicle is palpable which does not transilluminate with light.

Key Points

• Testicular cancer is the most common malignancy in young adults.

• A painless testicular mass is an important sign. Although 10% of patients may present with painful swelling due to associated haemorrhage or infection.

• 5-10% of patients may not present with a palpable mass but extra-testicular symptoms.

• Ultrasound with colour Doppler is the first standard investigation.

• Tumour markers include beta-HCG, AFP and LDH.

• Biopsy is not advised due to the risk of spreading.

• Radical inguinal orchiectomy is the initial treatment in most cases.

• Prognosis is generally excellent

Introduction

Epidemiology

Aetiology

Screening and Prevention

Diagnostic Approach : History 

Diagnostic Approach : Physical Examination 

Diagnostic Approach : Investigations 

Differential Diagnosis

Staging 

Management

Prognosis

Resources

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[2] Motzer RJ, Feldman DR, Bosl GJ, Testicular Cancer, Harrison’s Principles of Internal Medicine 19th Edition, 2015, p. 588-592.

[3] Downes MR, Seminoma, PathologyOutlines, 19 Apr 2022, https://www.pathologyoutlines.com/topic/testisseminomas.html. Last accessed 4 Dec 2022.

[4] Types of Testicular Cancer, Cancer Research UK, 06 Feb 2022, https://www.cancerresearchuk.org/about-cancer-testicular-cancer/types. Last accessed 4 Dec 2022.

[5] Sung H, Ferlay J, Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries, CA Cancer J Clin, 2021, 71(3): 209-249.

[6] Testicular Cancer Statistics, Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer#heading-Two. Last accessed 4 Dec 2022.

[7] Gurney JK, Florio AA, Znaor A et al. International trends in the incidence of testicular cancer: lessons from 35 years and 41 countries, Eur Urol, 2019, 76(5): 615-623.

[8] Petterson A, Richiardi L, Nordenskjold A, et al. Age at surgery for undescended testis and risk of testicular cancer, N Engl J med, 2007, 356(18): 1835-1841.

[9] Brierley JD, Gospodarowicz MK, Wittekind C, Union for International Cancer Control (UICC), TNM classification of malignant tumours 8th edition, 2017.

[10] Nichols CR, Catalano Pj, Crawford ED, et al. Randomised comparison of cisplatin and etoposide with either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumours, J Clin Oncol, 1998, 16(4): 1287-1293.

[11] International Germ Cell Cancer Collaborative Group, International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers, J Clin Oncol, 1997, 15(2): 594-603.

Authors: Emma Khoury, Thitikorn Nuamek