Introduction

Testicular cancer is the most common malignancy in men aged 20-30 years.

Epidemiology

  • Incidence: 3.50 cases per 100,000 person-years
  • Peak incidence: 30-40 years
Condition Relative
incidence
Epididymo-orchitis57.14
Testicular cancer1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors include:
  • Infertility (increases risk by a factor of 3)
  • Cryptorchidism
  • Family history
  • Klinefelter's syndrome
  • Mumps orchitis

Pathophysiology

Around 95% of cases of testicular cancer are germ-cell tumours. Germ cell tumours may essentially be divided into:
  • Seminomas
  • Non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma

Non-germ cell tumours include Leydig cell tumours and sarcomas.

Clinical features

  • A painless lump is the most common presenting symptom
  • Pain may also be present in a minority of men
  • Other possible features include hydrocele, gynaecomastia
  • AFP is elevated in around 60% of germ cell tumours
  • LDH is elevated in around 40% of germ cell tumours
  • Seminomas: hCG may be elevated in around 20%

Referral criteria

NICE cancer referral guidelines for testicular cancer suggest the following:


Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for testicular cancer in men if they have a non‑painful enlargement or change in shape or texture of the testis.

Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms.

Investigations

  • Ultrasound is first-line

Management

  • Treatment depends on whether the tumour is a seminoma or a non-seminoma
  • Orchidectomy
  • Chemotherapy and radiotherapy may be given depending on staging and tumour type

Prognosis

Prognosis is generally excellent
  • 5 year survival for seminomas is around 95% if Stage I
  • 5 year survival for teratomas is around 85% if Stage I