Testicular cancers are uncommon malignancy in general population.
However, primary testicular tumors are the most common solid malignant
tumors in men between ages 20 and 35 years old. In the United States,
incidence of testicular cancers is about 9,000 cases with about 300 to 400
deaths annually. The lifetime risk of Americans to develop testicular cancer
is about 1 in every 265 and the risk of dying is just 1 in 5,000.
Testicular cancers are mostly 95% germ cell tumors that are divided into two major types; pure seminoma and nonseminomatous germ cell tumors. These tumors are further subdivided into several subtypes depending on the histological features. The course and prognosis of the disease depend on to which subtype they fall.
Testicular cancer has been studied for a long time, but the exact cause of the disease is still unknown. Scientists consider multiple factors that predisposes a patient to develop this germ cell-derived tumor. One factor is genetic predisposition. Several studies revealed that 1st degree relatives have higher risk of developing this cancer compared to the general population. A son of an affected patient has 5 times increased risk while a sibling of an affected patient has up to 8 times increased risk of developing the disease.
A condition called cryptorchidism also carries high risk of developing this cancer. It is a condition wherein the testis fails to descend from the abdomen to the scrotum during the fetal period. This is also linked to exposure of diethylstilbestrol which is a chemical pointed out to be the cause of such condition.
There are other risk factors correlated with higher risk to develop this disease, but none are more important than a prior history of testicular cancer. Patients who were already diagnosed to have testicular cancer have a 500-fold higher rate to develop second primary testicular tumor compared to the general population.
Painless swelling or a nodule palpated in one testicle is the most common presenting sign. However, in cases where the cancer cells have already spread, patient may present with cervical lymphadenopathies or a neck mass. Metastatic disease may also present with systemic signs and symptoms of cancer such as fever, anorexia and weight loss.
A combination of high index of suspicion, blood tests and imaging modalities are necessary to diagnose testicular cancer. The presence of a mass indicates imaging studies. Ultrasonography can determine and assess the features of this mass. Seminomas usually appear as well-defined hypoechoic lesions without cystic areas while nonseminomatous tumors are typically hyperechoic with calcifications. A computerized tomography (CT) scan is also recommended to identify the presence of any regional metastasis. Blood tests such as lactose dehydrogenase (LDH) and beta subunit of human chorionic (beta-hCG) are usually elevated in the presence of a germ cell tumor.
Testicular cancers are usually managed depending on its stage. The initial management is to do a procedure called Radical Inguinal Orchiectomy. This procedure allows histologic evaluation of the mass to determine the stage, and at the same time, it provides local control of the tumor. In early and even late stage of this malignancy, a specific chemotherapy is done. A strict guideline has already been established on what chemical agents should be used in specific stages of testicular cancer. Surgical resection is saved for cases where tumor recurs after chemotherapy.
Prognosis depends to what stage the cancer was when diagnosed. Early stages could have 5-year survival rate of up to 92% while late stages would have the highest 5-year survival rate at 48%. In general seminomas have better prognosis than nonseminomatous tumors but the latter is are rare and still have a relatively higher prognosis compared to other types of cancer such as that of the lungs and colon.