Testicular Cancer
Testicular cancer is the most common malignancy affecting men aged 20 – 30 years. Most are germ cell tumours (>95%), of which there are two main types: seminomas and teratomas. Recent classification divides testicular cancer into seminoma (50%) and non-seminoma germ cell tumours (including teratomas). Both types can occur together.
Testicular cancer accounts for 1 – 2% of all tumours. They mostly occur between 14 – 40 years of age.
Teratoma vs Seminoma
| Teratoma | Seminoma | |
|---|---|---|
| Age of onset | 20 – 30 | 30 – 40 |
| Peak incidence | 25 years | 35 years |
| aFP | Produced | Not produced |
| B-hCG | Produced | Produced |
| 5-year survival if stage I | 85% | 95% |
- Risk factors for testicular cancer
- Cryptorchidism
- Klinefelter’s syndrome
- Male infertility (3 times risk)
- Low birth weight
- Infantile hernia
- Height (taller men are at a greater risk)
- History of testicular cancer (in the contralateral testis)
- Family history of testicular cancer (50 times increased risk with TCGT1 gene which is carried by 20% of the population)
- Mumps orchitis
- Signs and symptoms
- Firm lump on the testes
- Painless (rarely painfull)
- “Stuck on” to the side of the testes
- Hard
- Testicular “ache” or abdominal pain
- Sensation of “dragging” or “anchoring” on the scrotum
- Hydrocele
- Gynaecomastia (due to B-hCG produced by the tumor)
- Firm lump on the testes
- Differentials
- Hernia
- Hydrocele
- Varicocele
- Testicular torsion
- Epididymo-orchitis
- Investigations
- Ultrasound
- Thoraco-abdominal CT scan: for staging after diagnosis
- Tumour markers
- a-fetoprotein. (AFP)
- B-human chorionic gonadotrophin (hCG)
- Lactate dehydrogenase (LDH)
- Treatment
- Radical orchidectomy: The affected testes and spermatic cord are removed preferably through the inguinal route to minimise risk of seeding into the scrotum
- Chemotherapy (bleomycin, etoposide, cisplatin – BEP)
- Radiotherapy
