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Epidemiology of and risk factors for testicular germ cell tumors

M Dror Michaelson, MD, PhD
William K Oh, MD
Section Editor
Philip W Kantoff, MD
Deputy Editor
Michael E Ross, MD


Germ cell tumors (GCTs) account for 95 percent of testicular cancers; they are divided evenly between seminomas and nonseminomatous GCTs. Testicular GCTs are rare prior to puberty [1].

Other testicular malignancies include sex cord-stromal tumors, including Leydig cell and Sertoli cell tumors, gonadoblastoma, and tumors of other cell types presenting in the testes such as lymphoma, carcinoid tumors, and metastatic carcinoma (table 1). (See "Anatomy and pathology of testicular 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 partner. 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. In another 10 percent, the presenting manifestations of testicular cancer are attributable to metastatic disease; symptoms vary with the site of metastasis. Approximately 5 percent have gynecomastia. (See "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors" and "Clinical features, diagnosis, and evaluation of gynecomastia in adults".)

The presentation is different in Leydig cell tumors, which account for 2 percent of testicular tumors. Only 10 percent are malignant, and the clinical presentation is dominated by symptoms of excess estrogen and reduced testosterone [2-4]. There is a bimodal distribution of these tumors; they are found in 6- to 10-year-old boys who present with precocious puberty, and in 26- to 35-year-old men who present with a testicular mass, gynecomastia, impotence, and loss of libido. Sertoli cell tumors are even less common and also present with symptoms of excess estrogen.


Approximately 8850 men are diagnosed with testicular cancer each year in the United States alone, but only approximately 400 men will die of their disease [5]. Worldwide, there are approximately 72,000 cases and 9000 deaths per year due to testicular cancer [6].

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Literature review current through: Nov 2017. | This topic last updated: Jan 10, 2017.
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