Chapter 86 • One percent of all male malignancies, accounting for 6000 to 8000 new cases a year in the United States • Most common malignancy among men aged 15 to 35 • Germ cell tumors: 95% of all testicular cancers • Pure seminoma: 40% of all germ cell tumors • Nonseminoma: 60% of all germ cell tumors, with embryonal elements most frequent • Complete history and physical examination • Bilateral testicular ultrasonography • Tumor serum markers (lactate dehydrogenase [LDH], β-human chorionic gonadotropin [β-hCG], and α-fetoprotein [AFP]) • Complete blood count, chemistry studies including renal function • Computed tomography (CT) of chest, abdomen, and pelvis • Additional imaging studies as appropriate (e.g., imaging of brain in patient with pure choriocarcinoma) • Radical (inguinal) orchiectomy (transscrotal biopsy or orchiectomy should be avoided) • Localized disease is curable with orchiectomy alone. Both adjuvant chemotherapy and adjuvant low-dose radiotherapy to lymph nodes can reduce the risk of relapse. • Locally advanced disease (stage IIA/IIB) is curable in more than 90% of patients with orchiectomy plus radiotherapy to involved nodal areas or with combination chemotherapy. • Metastatic disease (stage III) or bulky locally advanced disease (stage IIB/IIC) is curable in 90% with combination chemotherapy • Postchemotherapy retroperitoneal lymphadenectomy can prevent subsequent relapse in select patients
Testicular Cancer
Summary of Key Points
Incidence
Diagnosis and Staging Evaluation
Primary Therapy
Seminoma
