There are approximately 8,800 new diagnosis of testis cancer each year, which account for 0.5% of all new cancer diagnoses. Most testis tumors present with a painless mass or swelling in the testis. The patient's exam typically reveals a firm, nontender testis mass. Men between 20 and 34 years of age are at highest risk of testis cancer, with decreasing risk over time.
An abnormal testicular exam will trigger a full workup including tumor markers (HCG, AFP, B-HCG), testicular ultrasound and cross-sectional imaging (CT or MRI) to evaluate for metastatic disease. Unless bulky metastatic disease is seen, the patient will need to undergo radical orchiectomy. During this procedure, the affected testis will be removed through an incision in the groin as to not violate or disturb the lymphatic channels in the scrotum. The pathologist will evaluate for the type of tumor cells present which, in conjunction with postoperative tumor marker levels, will determine further therapy.
Testis cancers are categorized as "germ cell" and "non-germ cell" tumors. Germ cell tumors (GCT) are the most common types of testis cancer and are further classified into "seminoma" versus "nonseminoma." Each classification of tumor has different prognosis and available treatment options. For instance, semonimatous tumors are highly chemo and radiation sensitive while nonseminomatous germ cell tumors are radiation resistant. Following radical orchiectomy, further treatment options include active surveillance, chemotherapy, radiation therapy, or retroperitoneal lymph node dissection (RPLND)-- surgery to remove lymph nodes. Patients with testis cancer will also be observed long term with routine labs and cross-sectional imaging to evaluate for tumor recurrence.
Prompt evaluation and treatment of testis cancer is crucial. Tumors detected at an early stage have the highest rates of cure, with up to 95% cure rate in tumors limited to testis with favorable histology. Routine self testicular exams are highly recommended in young men. Any abnormal testicular exam should be evaluated by your primary physician and referred to a urologist if indicated.