Clinical manifestations, diagnosis, and staging of testicular germ cell tumors
- Graeme S Steele, MBBCh, FCS
Graeme S Steele, MBBCh, FCS
- Assistant Professor of Surgery
- Harvard Medical School
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- William K Oh, MD
William K Oh, MD
- Section Editor — Testicular Cancer
- Professor of Medicine
- Mount Sinai School of Medicine
- Chief, Division of Hematology Oncology
- Tisch Cancer Institute
- M Dror Michaelson, MD, PhD
M Dror Michaelson, MD, PhD
- Associate Professor in Medicine
- Harvard Medical School
Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1 percent of all cancers in men . Germ cell tumors (GCTs) account for 95 percent of testicular cancers (table 1). They may consist of one predominant histologic pattern or represent a mix of multiple histologic types. For treatment purposes, two broad categories of testis tumors are recognized: pure seminoma (no nonseminomatous elements present), and all others, which together are termed nonseminomatous germ cell tumors (NSGCTs). In most series, the ratio of seminoma to NSGCT is about one.
Testicular cancer has become one of the most curable of solid neoplasms because of remarkable treatment advances beginning in the late 1970s. Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 to 34, and the five-year survival rate was 64 percent . In 2017, approximately 400 deaths from testicular cancer are expected in the United States, with a five-year survival rate over 95 percent .
The clinical manifestations, diagnosis, and staging of testicular cancer will be presented here. Optimal therapy, which varies with the stage of disease, is discussed separately. (See "Overview of the treatment of testicular germ cell tumors".)
Testicular tumors usually present as a nodule or painless swelling of one testicle, which may be noted incidentally by the patient or by his sexual partner . Occasionally, a man with a previously small atrophic testis will note enlargement. Approximately 30 to 40 percent of patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum, while acute pain is the presenting symptom in 10 percent.
The presenting manifestations of testicular cancer are attributable to metastatic disease in approximately 10 percent of patients. Symptoms vary with the site of metastasis:
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- CLINICAL MANIFESTATIONS
- Testicular examination
- - Cryptorchidism
- DIAGNOSTIC EVALUATION
- Scrotal ultrasound
- CT scan
- PET scan
- Serum tumor markers
- Radical inguinal orchiectomy
- Contralateral testicular biopsy
- Retroperitoneal lymph node dissection
- CRYOPRESERVATION OF SPERM
- INFORMATION FOR PATIENTS