Case Discussion - Testicular Tumors

Testicular Tumors
Testicular cancer is the

most common cancer in
younger men ages between
15 45 with over 2,300
cases diagnosed per year

98% cure rates are possible
if found at an early stage

Even when testicular cancer
has spread to other areas of
the body, cure can still be
achieve
St. Bartholomews Hospital, London
www.orchid-cancer.org.uk

Number of New Cases and Deaths per
100,000 from 1992-2011

Estimated New
Cases in 2014
8,820
% of All New
Cancer Cases
0.5%
National Cancer Institute: Surveillance, Epidemiology, and End
Results (SEER) Program
Estimated
Deaths in 2014
380
% of all cancer
deaths
0.1%
Relative Survival of 5yrs or more after
Diagnosis of Testicular Cancer
National Cancer Institute: Surveillance, Epidemiology, and End Results
(SEER) Program

Percent Surviving
5 Years
95.3 %
Percent of Cases & 5-Year Relative
Survival by Stage at Diagnosis: Testis
Cancer
National Cancer Institute: Surveillance, Epidemiology, and End Results
(SEER) Program

Localized (68%)
Confined to
Primary Site
Regional (18%)
Spread to Regional
Lymph Nodes
Distant (12%)
Cancer Has
Metastasized
Unknown (1%)
Unstaged
Compared to other cancers, testis
cancer is rare
Common Types of
Cancer
Estimated New
Cases 2014
Estimated
Deaths 2014
Prostate Cancer 233,000 29,480
Breast Cancer
(Female)
232,670 40,000
Lung and Bronchus
Cancer
224,210 159,260
Colon and Rectum
Cancer
136,830 50,310
Melanoma of the Skin 76,100 9,710
Bladder Cancer 74,690 15,580
Non-Hodgkin
Lymphoma
70,800 18,990
Kidney and Renal
Pelvis Cancer
63,920 13,860
Thyroid Cancer 62,980 1,890
Endometrial Cancer 52,630 8,590
- - -
Testis Cancer 8,820 380
National Cancer Institute: Surveillance, Epidemiology, and
End Results (SEER) Program

Testis cancer
represents 0.5% of all
new cancer cases
0.5%
Background: Incidence
GCTs are the most common solid tumors in
men between the ages of 15 and 35 years.
In a man aged 50 or older, a solid testicular
mass should be regarded as lymphoma until
proven otherwise.
Devita, Hellman & Rosenberg's Cancer: Principles & Practice of
Oncology, 8th Edition
Percent of New Cases by Age Group:
Testis Cancer

Median Age
At Diagnosis
33
Testis cancer is
most frequently
diagnosed among
men aged 20-34.
Percent of Deaths by Age Group:
Testis Cancer

Median Age
At Death
41
The percent of
testis cancer
deaths is highest
among men aged
20-34.
Number of New Cases per 100,000
Persons by Race/Ethnicity: Testis
Cancer

Epidemiology:
Familial clustering has been observed,
particularly among siblings.
Studies have failed to identify an association
between vasectomy, diethylstilbestrol exposure,
trauma, or viral infection, and GCT.
More recently, testicular cancer has been
reported in men infected with HIV; however, few
data support a higher incidence of GCT in HIV-
infected individuals, and the results of treatment
are similar.
Devita, Hellman & Rosenberg's Cancer: Principles & Practice of
Oncology, 8th Edition
Epidemiology: Philippines
Cases of testicular and prostate cancers, which
are the leading cause of cancer deaths in men
20-35yo and second most common cancer in
men are increasingly becoming a cause for
concern
14
th
Congress of the Republic of the Philippines
http://www.senate.gov.ph/
Epidemiology: Philippines
In the study M.T.M. Redaniel, A.V. Laudico,
et.al., Cancer in the Philippines

From a total of 27, 130 male subjects from Metro
Manila & Rizal Provinces, 248 (0.9%) had testicular
tumor

Vol. IV Part 1 Cancer incidence 1998-2002

Possible Risk Factors:
Cryptorchidism
Carcinoma in situ
Brother/father w/
testicular CA
Previous history of
testicular CA
Sedentary lifestyle
Repeated trauma
(rather than
inevitable knocks)
Smoking marijuana
Men with HIV are up
to twice as likely to
develop testicular
CA


Cryptorchidism
Associated with several-fold higher risk of GCT
Abdominal cryptorchid testis are at higher risk
than inguinal cryptorchid testis
Orchidopexy should be performed before
puberty
Early orchidopexy reduces the risk of GCT and
improves the ability to save the testis
Longo, Fauci, et.al. Harrisons Principles of Internal Medicine 18
th
ed, 2012
Cryptorchidism
Associated with 10% of testicular GCTs
The most important risk factor
Part of a spectrum of d/o known as testicular
dysgenesis syndrome (TDS):
Cryptorchidism
Hypospadias
Poor sperm quality

Kumar, Abbas, Fausto, Aster Robbins & Cotran
Pathologic Basis of Disease 8
th
ed
Cryptorchidism
In the cohort study by Pettersson et.al., on
men who underwent orchiopexy for
undescended testis at Sweden between 1964-
1999, they determined the age at treatment
for undescended testis and the risk of
testicular cancer
They concluded that, treatment for
undescended testis before puberty decreases
the risk of testicular cancer
Age at surgery for undescended testis and risk of testicular cancer
http://www.ncbi.nlm.nih.gov/pubmed

Cryptorchidism
In the systematic review & meta-analysis by
Walsh TJ, et.al., determines whether
orchiopexy affects the natural history of
testicular cancer development
They concluded that, early surgical
intervention is indicated in children with
cryptorchidism
Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular
cancer 2007
http://www.ncbi.nlm.nih.gov/pubmed

Marijuana Use
In a case control study, researchers found that
men with testicular tumors were about twice
as likely to have a history of using marijuana.
Most of the increased risk was found in men
with a germ cell tumor sub-type called non-
seminomas.
American Cancer Society 2012
http://www.cancer.org/cancer/news/study-
links-marijuana-use-to-testicular-cancer
Possible Risk Factors:
Cryptorchidism
Carcinoma in situ
Brother/father w/
testicular CA
Previous history of
testicular CA
Sedentary lifestyle
Repeated trauma
(rather than
inevitable knocks)
Smoking marijuana
Men with HIV are up
to twice as likely to
develop testicular
CA


Genetics
th
ed, 2012

i12p
Pathognomonic of GCT
of all histologic types
Histologic Types

Most are
aggressive
cancers
Generally,
benign
Clinical Presentation
Painless testicular
mass
Testicular
discomfort/swelling
Backpain
Dyspnea Gynecomastia
th
ed, 2012

Painless testicular mass Swelling
(orchitis/epididymitis)

Trial of antibiotics

Ultrasound Persistence

(+) Mass Radical inguinal orchiectomy
th
ed, 2012

(+) Mass Radical inguinal orchiectomy

CXR, CT of abd & pelvis

th
ed, 2012

Staging
Includes determination serum
AFP
hCG
LDH
th
ed, 2012

Staging

Staging



Pathology
Nonseminomatous GCTs
Choriocarcinoma
Consisting of cyto- & syncytiotrophoblast
Malignant trophoblastic differentiation
Assoc w/ hCG secretion
Highly malignant

Choriocarcinoma
Pathology
Endodermal sinus tumor (yolk-sac tumor)
Assoc w/ secretion of AFP
Most common in infants & children up to 3yo
Good prognosis
Usually mixed w/ embryonal CA
Yolk-sac tumor

Pathology
Pure Embryonal Carcinoma
May secrete AFP or hCG or both
Mostly in 20-30 age group
More aggressive than seminomas
Embryonal Carcinoma
Pathology
Teratoma
Composed of somatic cell types derived from 2 or more
germ layers
Occur at any age
Teratoma
Pathology
Seminomatous GCTs
Seminoma
50% of all GCTs
Peak at 30s, never occurred in infants
More indolent clinical course
70% pt presents w/ stage I disease
Lung & visceral metastasis are rare
Seminoma
Treatment
th
ed, 2012

Case Discussion - Testicular Tumors

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