Testicular Cancer

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Testicular cancer is a malignant tumour arising from the testicular tissue. It is the most common cancer in young men aged 15–35 years but has a high cure rate with early detection.

Aetiology

Testicular cancer is classified based on histology:

1. Germ Cell Tumours (90–95% of cases):

  • Seminomas (40–50%): slow growing, highly radiosensitive.
  • Non seminomas (30–40%): includes embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma.

2. Non Germ Cell Tumours (Rare):

  • Sertoli cell tumours: usually benign.
  • Leydig cell tumours: may secrete androgens or oestrogens.

Pathophysiology

  • Originates from intratubular germ cell neoplasia.
  • Germ cell mutations lead to uncontrolled cell proliferation.
  • Seminomas grow slowly and spread via lymphatics.
  • Non-seminomas grow rapidly and spread haematogenously.

Risk Factors

  • Cryptorchidism (undescended testes).
  • Family history of testicular cancer.
  • Klinefelter syndrome.
  • Previous testicular cancer (increased risk in contralateral testis).
  • Testicular atrophy (due to trauma or infection).
  • Infertility.

Signs and Symptoms

  • Painless testicular lump: most common presentation.
  • Testicular heaviness: sensation of fullness or dragging.
  • Scrotal swelling: often mistaken for hydrocele.
  • Gynaecomastia: if tumour produces oestrogens.
  • Back pain: suggests retroperitoneal lymph node involvement.
  • Respiratory symptoms: haematogenous spread to lungs can cause dyspnoea or haemoptysis.

Investigations

  • Scrotal ultrasound: first line imaging to assess testicular mass.
  • Tumour markers:
    • Alpha-fetoprotein (AFP): elevated in non-seminomas.
    • Beta-human chorionic gonadotropin (β-hCG): elevated in non-seminomas and some seminomas.
    • Lactate dehydrogenase (LDH): a general marker of tumour burden.
  • CT scan (chest/abdomen/pelvis): staging to detect metastases.
  • Orchidectomy (definitive diagnosis): histological examination post-surgical removal.

Management

1. Radical Inguinal Orchidectomy:

  • First line treatment for all suspected testicular tumours.
  • Prevents local spread and provides histological diagnosis.

2. Adjuvant Therapy (Based on Stage and Type):

Seminomas:
  • Stage I: surveillance or single-dose carboplatin.
  • Stage II–III: chemotherapy (BEP: Bleomycin, Etoposide, Cisplatin) or radiotherapy.
Non-Seminomas:
  • Stage I: surveillance or chemotherapy if high-risk.
  • Stage II–III: BEP chemotherapy ± retroperitoneal lymph node dissection.

3. Metastatic Disease:

  • Platinum based chemotherapy (BEP regimen).
  • Surgical resection of residual masses if necessary.

4. Long-Term Monitoring:

  • Regular tumour marker monitoring post-treatment.
  • Surveillance CT scans to detect recurrence.
  • Testicular self examination advice for future risk reduction.
RenalmypanotesTesticular Cancer