Testicular Malignancies

Testicular Malignancies is a topic covered in the 5-Minute Clinical Consult.

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  • Testicular cancer accounts for <1% of all cancers in men; it is the most common solid malignancy in men aged 20 to 34 years (1).
  • An estimated 9,310 new cases were diagnosed, and an estimated 400 deaths occurred in the United States in 2018 (2).
  • Rates for new cases have been rising 0.8% each year over the last 10 years, but death rates have been stable.
  • The median age at diagnosis is 33 years. The median age at death is 42 years (2).
  • Treatment produces an overall 5-year survival of 95.3%; for African American patients, this 5-year survival rate is alarmingly lower but has improved from 86% to 90% (2).

Etiology and Pathophysiology

95% of all malignant tumors arising in the testes are germ cell tumors (GCTs), which are subclassified as follows:

  • Seminomatous GCTs: most common type overall
  • Nonseminomatous GCTs (NSGCTs): These include embryonal cell carcinoma, choriocarcinoma, yolk sac tumor, teratomas, or often multiple cell types; these are more clinically aggressive tumors.

Risk Factors

  • Cryptorchidism is the most firmly established risk factor: Relative risk of testicular cancer in all patients with cryptorchidism is 3 to 8, with a lower relative risk of 2 to 3 in those undergoing orchiopexy by age 12 years; in patients with unilateral cryptorchidism, the relative risk of testicular cancer in the contralateral normally descended testis is negligible (3).
  • Personal history of testicular cancer
  • Use of muscle building supplements
  • Positive family history for testicular cancer
  • Testicular dysgenesis
  • Klinefelter syndrome
  • Caucasian race
  • HIV infections

General Prevention

No evidence that screening for testicular cancer is effective (4)

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