95 % of testicular cancers are germ cell tumours.
1 % of cancers overall, 5 % of urological malignancies.
Most common cancer in men 15 – 35.
Peak incidence 3rd decade for non-seminoma/mixed, and 4th decade for seminoma
Incidence seems to be rising.
< 15 % present with distant or metastatic disease.
Presentation is generally with a painless hard testicular mass, although rarely may be from metastatic disease (lymphatic obstruction, lung metastases).
Risk factors
- Cryptorchidism
- Infertility / testicular dysgenesis syndrome
- Family history
- Personal history
- GCNIS
- Klinefelter’s
- HIV infection
- Caucasian
Cryptorchidism
- 4 – 6 x risk of testis cancer cf. normal population
- Risk falls to 2 – 3 x with early orchidopexy
- 7 – 10 % of testis cancer diagnoses will be in men with history of cryptorchidism
- Intra-abdominal testis highest risk
- The contra-lateral testis is at slightly higher risk also even if descended
Infertility / testicular dysgenesis
- Encompassing cryptorchidism, hypospadias, impaired spermatogenesis, and DSD
- 5 – 3 x risk of testis cancer for men with infertility
Family and personal history
- 4 – 8 x risk for men with first degree male relative (brother > father)
- Men with personal history of testis cancer much more likely to develop tumour in contra-lateral testis (12 x relative risk, but cumulative incidence low only 2 % at 15 yrs)
GCNIS
- Most germ cell tumours arise from GCNIS except pre-pubertal cancers and spermatocytic seminoma
- GCNIS present in adjacent tissue to invasive tumour in > 80 % of cases, with > 50 – 70 % risk of progression to cancer if untreated
- 5 – 9 % of men will have GCNIS of contra-lateral testis, which is higher again with cryptorchidism
Other risk factors
- Klinefelter’s
- More commonly associated with mediastinal germ cell tumours
- HIV infection
- Increased risk of seminoma (risk negative with antiviral treatment)
- Caucasian > black in US