Testicular tumours are relatively rare and accounts for 1-1.5% of male cancers (1).
- it is rare before puberty but is the most common tumour in young and middle aged men (usually in males between the ages of 15-49) (2),
- in 2010, 62% of newly diagnosed cases of testicular cancer in England were in men under 40 (3)
- incidence rates peak at around 17 or 18 per 100,000 in the 25-34 age group (2)
Testicular tumours can be divided into:
- germ cell tumours (GCTs)
- 90-95% of testicular tumours
- e.g. - Seminoma, Spermatocytic seminoma
- lymphomas
- about 4% of testicular tumours
- almost always found in men aged over 50 years
- generally treated as a different disease entity from GCTs
- cord stromal tumours
- e.g. - Leydig cell tumour, Sertoli cell tumour
- uncommon and usually benign
- rare tumours
- arising in paratesticular structures include rhabdomyosarcomas in children and liposarcomas in older men (4)
SIGN have suggested (5):
- presenting symptoms/history of patients with testicular cancer include:
- a painless, solid, unilateral mass in the scrotum (majority of cases)
- enlarged testicle
- scrotal pain (20% of cases)
- backache (10%)
- gynaecomastia (7%)
- dragging sensation in the scrotum
- incidental recent trauma (It is not thought that the trauma causes the cancer, but rather that it brings an existing tumour to the attention of the patient and physician).
The incidence is increasing specially in white Caucasian populations throughout the world, the condition having been virtually unknown at the start of the century (2).
A high proportion (96%) of testicular cancer cases in Northern Ireland have stage at diagnosis recorded (2)
- testicular cancer patients with a known stage are most commonly diagnosed at stage I (77%)
- more patients with a known stage are diagnosed at an early stage (91% are diagnosed at stage I or II), than a late stage (9% are diagnosed at stage III or IV). Only 1% of patients have metastases at diagnosis (stage IV)
Risk of recurrence of testicular cancer after treatment for testicular cancer:
- hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC)
- a study (6) showed overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8)
- second TC incidence was also lower for those age >= 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1)
- overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0)
Testicular germ cell tumors (GCTs) are considered a curable cancer owing to the >95% cure rate in all patients and approximately 90% cure rate in patients with metastatic disease (7)
- implementation of cisplatin based chemotherapy regimens and the refinement of surgical procedures have led to a radical change in the prognosis of GCTs
- incidence of GCTs has been steadily rising during the past 30 years in characteristic regions
- in 2020, the highest incidence was estimated in Scandinavian countries, western and central Europe (7-11 cases per 100,000), US and Canada (5-6 cases per 100,000), and Australia and Japan (7 and 4 cases per 100,000, respectively)
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