Testis Cancer

Risk Factors

The strongest association is that with the undescended testicle. About 7% of testicular tumors develop in those with a history of undescended testes, and seminoma arises most commonly. The relative risk of tumor formation is much higher for those with an intra-abdominal testis, and placement of the undescended testicle into the scrotum does not alter the potential for malignancy. Also, the tumor may develop in the contralateral normally-placed testicle. Estrogen hormones given to the mother during pregnancy are also associated with an increased risk for testicular tumors.

Treatment of Testicular Cancer

Surgical removal of the testicle through the groin is the standard approach. Additional treatment depends on the tumor type as well as the spread, if any.

Seminomatous Tumors

These are the most common testicular tumor and is very radiosensitive. Those with low spread can be treated with radiation alone, although those with high volume spread of the disease will receive primary chemotherapy. Chemotherapy is given to those patients with bulky seminoma and any of those seminomas where the serum marker alpha fetoprotein is elevated. Rarely, surgical excision of residual masses after chemotherapy may be necessary.

Non-Seminomatous Tumors

Non-seminomatous germ cell tumors (NSGCT) include embryonal carcinoma, teratoma, choriocarcinoma and mixed tumors.

Many of those with low stage disease may be followed with surveillance. Follow up continues rigorously for 3 years and gradually tapers over a considerable period beyond that. However, most relapses occur within the first year, and most will respond to chemotherapy and/or surgery.

Retroperitoneal lymph node dissection (RPLND) is performed if the surveillance protocol is not adopted. Ejaculation can be maintained by preserving the important sympathetic nerve fibers below the inferior mesenteric artery, at least on one side of the dissection.

In high volume or bulky spread of NSGCTs, various combinations of chemotherapy and/or RPLND may be advocated.

The rate of decline of serum tumor markers during chemotherapy may be useful in predicting response in patients with advanced disease.

The biochemical markers useful in the diagnosis and management of testicular carcinoma include alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactic acid dehydrogenase (LDH).