Testicular Cancer

– Most carcinomas of the testes are germ cell in origin and are either seminomas or nonseminomas.

Causes and Incidence

The etiology of testicular cancer is unknown, although it occurs 40 times more often in men with undescended or atrophic testicles. Testicular cancer accounts for only 1% of all cancer in men in the United States. However, it is the most common solid malignancy in males under 30 years of age. Male offspring of mothers who received diethylstilbestrol during pregnancy are at higher risk.

Disease Process

The cells arise from the primordial germ cell and grow within the testis itself. The cancer forms a solid mass and then metastasizes via regional lymph nodes to the retroperitoneum and distantly to the lungs.

Symptoms

The most common presenting sign is a scrotal mass with or without local tenderness and pain.

Potential Complications

The prognosis is excellent if the condition is treated before metastasis occurs in the lymph nodes. Ureteral obstruction is a complication.

Diagnostic Tests

Palpation and ultrasound and computed tomography scans are used to locate suspicious lesions.Alpha-fetoprotein and human chorionic gonadotropin serum markers are elevated. A biopsy through orchiectomy is used for definitive diagnosis.

Treatments

Surgery
Inguinal orchiectomy with or without transabdominal retroperitoneal lymph node dissection is the primary treatment; testicular implants.

Drugs
Chemotherapy (cisplatin alone or in combination) to promote regression of tumors, making them more amenable to surgery.

General
Radiation to treat seminomas; counseling for altered sexual functioning, infertility; referral for sperm banking for future children; instruction in testicular self-examination.