Testicular cancer

Definition

• Testicular cancer: A malignant tumour originating from the testicles (testes).

Epidemiology

• Most common cancer in men aged 15-35 years in the UK.
• Higher incidence in Caucasian men.
• Undescended testes (cryptorchidism) increases risk.

Pathophysiology

• Majority are germ cell tumours: either seminomas or non-seminomas.
• Other types: Leydig cell tumours, Sertoli cell tumours, and lymphomas (rare).

Clinical Presentation

• Painless lump or swelling in one testicle.
• Dragging sensation or testicular discomfort.
• Advanced disease: Back pain, weight loss, and symptoms of metastasis.
• Gynaecomastia in cases with high hCG production.

Investigations

• Scrotal ultrasound: First-line imaging.
• AFP, hCG, and LDH: Tumour markers.
• Chest X-ray, CT, and MRI: To check for metastasis.
• Testicular biopsy: Rarely done due to risk of spread; orchiectomy is diagnostic and therapeutic.

Management

• Orchiectomy: Surgical removal of the affected testicle.
• Surveillance post-surgery for early-stage disease.
• Chemotherapy, especially for non-seminomas.
• Radiation therapy primarily for seminomas.
• Retroperitoneal lymph node dissection in some cases.

Prognosis

• Highly treatable, especially when detected early.
• 5-year survival rate exceeds 95% for localised disease.

Complications

• Metastasis, commonly to lungs, liver, and brain.
• Infertility due to treatment or bilateral disease.