Testicular cancer overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]
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Overview
Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Testicular cancer may be classified according to cell types into two subtypes: germ cell tumors and non–germ cell tumors.Testicular cancer must be differentiated from epididymitis, hematocele, hydrocele, spermatocele, granulomatous orchitis, and varicocele. The prevalence of testicular cancer is approximately 88.1 per 100,000 males in the United States. The incidence of testicular cancer is approximately 5.88 per 100,000 males in the United States. Common risk factors in the development of testicular cancer are undescended testicle, family history, personal history of testicular cancer, Klinefelter syndrome.The most common symptoms of testicular cancer include a painless lump in the testicle, swelling of the testicle, and weight loss. An elevated concentration of blood tumor marker tests is diagnostic of testicular cancer. The predominant therapy for testicular cancer is surgical resection. Adjunctive chemotherapy and radiation therapy may be required. Prognosis of testicular cancer is generally good, and the 5-year survival rate is approximately 96.6%.
Historical Prospestive
There is a limited information about the historical perspective of testicular germ cell tumors. Leydig cells were first discovered by Franz Leydig who was a German anatomist in 1870.
Classification
Testicular cancer is a very rare type of cancer. Based on the histopathological features, testicular cancer may be classified into six subtypes: germ cell tumors, sex-cord stromal tumors, tumors containing both germ cell and sex-cord stromal elements, miscellaneous tumors of the testis, hematolymphoid tumors, and tumors of collecting duct and rete testis.
Pathophysiology
The pathophysiology of testicular cancer depends on the histological cell subtypes and findings. Most testicular cancers derived from the lack of differentiation of primordial germ cell into spermatogonia. Germ cells testicular tumor have some genetic component while most sex cord stromal testicular cancer are hormonal dependent. Most gross pathology of testicular tumors look similar on the physical appearance. On microscopic histopathological analysis of testicular cancer, fried-egg appearance is the characteristic finding of seminoma; marked nuclear atypia is the characteristic finding of embryonal carcinoma; hyaline-type globules, and Schiller-Duval bodies are characteristic findings of yolk sac tumor ; syncytiotrophoblasts and cytotrophoblast cells are the characteristic findings of choriocarcinoma, Polymorphism with"spirene" chromatin for spermatocytic.
Causes
There are no direct causes for testicular cancer. However, there are some common risk factors that may lead to gene mutations and cause the testicular cancer.
Differential Diagnosis
Testicular cancer must be differentiated from epididymitis, hematocele, hydrocele, spermatocele, granulomatous orchitis, and varicocele.
Epidemiology and Demographics
Testicular cancer is a rare type cancer accounting about 0.5% of all new cancer cases in U.S. In 2018, the estimate prevalence of testicular cancer is approximately 9,310 new cases of testicular cancers in the United States. The incidence of testicular cancer is approximately 5.7 per 100,000 men per year based on 2011-2015 report in the United States. The majority of cases are reported in New Zealand. Testicular cancer commonly affects more white males than any other races and black males are less affected by it. Testicular cancer is commonly affects men aged 20-44 years old and median age is 33 years old.
Risk Factors
Common risk factors in the development of testicular cancer are undescended testicle, family history, personal history of testicular cancer, Klinefelter syndrome.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for testicular cancer.<ref>testicular Cancer. U.S. Preventive Service Task Force (USPSTF) 2015.
Prognosis
Prognosis of testicular cancer is generally good, and the 5-year survival rate is approximately 96.6%.
Staging
Testicular cancer may be classified into several subtypes based on TNM system and the American Joint Committee on Cancer (AJCC).
History and Symptoms
The most common symptoms of testicular cancer include a painless lump in the testicle, swelling of the testicle, and weight loss.
Physical Examination
Common physical examination findings of testicular cancer include weight loss, swelling of the testicle , and a painless mass in the testicle.
Laboratory Findings
An elevated concentration of blood tumor marker tests is diagnostic of testicular cancer.
X Ray
There are no X-ray findings associated with testicular cancer.
CT Scan
CT scan may be helpful in the diagnosis of testicular cancer.
MRI
MRI may be helpful in the diagnosis of testicular cancer.
Ultrasound
Ultrasound may be helpful in the diagnosis of testicular cancer.
Other Imaging Findings
There are no other imaging findings associated with testicular cancer.
Other Diagnostic Findings
There are no other diagnostic findings associated with testicular cancer.
Biopsy
Biopsy is rarely done in the diagnosis of testicular cancer.
Medical Therapy
The predominant therapy for testicular cancer is surgical resection. Adjunctive chemotherapy and radiation therapy may be required.
Surgery
Surgery is the mainstay of treatment for testicular cancer.
Primary Prevention
Effective measures for the primary prevention of testicular cancer include healthy lifestyle and monthly testicular self-exams.
Secondary Prevention
There are no secondary preventive measures available for testicular cancer.