Testicular Cancer
Summary of Key Points
Incidence
• One percent of all male malignancies, accounting for 6000 to 8000 new cases a year in the United States
• Most common malignancy among men aged 15 to 35
• Germ cell tumors: 95% of all testicular cancers
• Pure seminoma: 40% of all germ cell tumors
• Nonseminoma: 60% of all germ cell tumors, with embryonal elements most frequent
Diagnosis and Staging Evaluation
• Complete history and physical examination
• Bilateral testicular ultrasonography
• Tumor serum markers (lactate dehydrogenase [LDH], β-human chorionic gonadotropin [β-hCG], and α-fetoprotein [AFP])
• Complete blood count, chemistry studies including renal function
• Computed tomography (CT) of chest, abdomen, and pelvis
• Additional imaging studies as appropriate (e.g., imaging of brain in patient with pure choriocarcinoma)
• Radical (inguinal) orchiectomy (transscrotal biopsy or orchiectomy should be avoided)
Primary Therapy
Seminoma
• Localized disease is curable with orchiectomy alone. Both adjuvant chemotherapy and adjuvant low-dose radiotherapy to lymph nodes can reduce the risk of relapse.
• Locally advanced disease (stage IIA/IIB) is curable in more than 90% of patients with orchiectomy plus radiotherapy to involved nodal areas or with combination chemotherapy.
• Metastatic disease (stage III) or bulky locally advanced disease (stage IIB/IIC) is curable in 90% with combination chemotherapy
• Postchemotherapy retroperitoneal lymphadenectomy can prevent subsequent relapse in select patients
