Testicular cancer
Testicular cancer is the most common solid tumor in men aged 15 to 35 and is usually cured even when metastatic, because germ cell tumors are exquisitely chemosensitive. A painless testicular mass is worked up with scrotal ultrasound and serum tumor markers, radical inguinal orchiectomy establishes the diagnosis and provides local control, and post-orchiectomy markers plus CT staging then guide surveillance, radiation, retroperitoneal lymph node dissection, or cisplatin-based chemotherapy.
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What this article covers
- Overview
Definition: a malignant germ cell tumor arising within the testis, divided histologically into pure seminoma and nonseminomatous germ cell tumors (embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma, often admixed).
- Epidemiology
Age distribution: the most common solid tumor diagnosed in men aged 15 to 35 years; roughly 9,000 new cases occur annually in the United States, only about 1% of all US cancer diagnoses.
- Risk factors
Cryptorchidism: an undescended testis carries a markedly increased risk of germ cell tumor, the strongest identified risk factor; orchiopexy does not fully eliminate it (Cryptorchidism).
- Pathophysiology
Germ cell origin: tumors arise from the germ cells that produce sperm within the seminiferous tubules, so risk tracks with any process disrupting normal germ cell development or descent.
- Clinical features
Painless testicular mass or swelling: the hallmark and most common presentation, a firm, non-tender, non-transilluminating, adherent nodule or diffuse enlargement of the testis.
- Differential diagnosis
Testicular torsion: sudden, severe unilateral pain with a high-riding, horizontally lying testis and absent cremasteric reflex; a surgical emergency needing immediate Doppler ultrasound and…
- Diagnosis
Confirmed by radical inguinal orchiectomy with imaging and marker support, not by biopsy: scrotal ultrasound demonstrates a solid intratesticular mass (cystic lesions are rarely malignant), serum…
- Management
First, radical inguinal orchiectomy for essentially every patient: provides diagnosis and local control simultaneously; discuss and arrange sperm cryopreservation before starting any further treatment.
- Complications
Chemotherapy-related long-term toxicity: cardiovascular disease, metabolic syndrome, pulmonary toxicity (particularly with bleomycin), hypogonadism, infertility, chronic kidney disease, and…
- Prognosis
Highly curable, even when metastatic: among the most curable solid malignancies, from germ cell tumor chemosensitivity to cisplatin-based regimens.
- Prevention
No proven primary prevention exists for sporadic disease; efforts focus on correcting known anatomic risk factors and early detection in high-risk men.
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