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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.

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