💡 With effective treatment, the overall five-year survival rate in testicular cancer is ~97%. Orchidectomy is both diagnostic and therapeutic. Discuss sperm banking early for men wishing to preserve fertility.

📖 About

95% of testicular cancers are primordial germ cell tumours.
Most common solid tumour in men aged 20–40.
In men >50, always consider testicular lymphoma.
Seminomas – best prognosis (>90% cure).
Choriocarcinomas – most aggressive, worst prognosis.

🧬 Aetiology

Split into Seminomas (≈50%) and Non-seminomatous germ cell tumours (NSGCTs).
Lymphatic drainage:
- Right testis → interaortocaval nodes (just below right renal vein).
- Left testis → para-aortic nodes (just below left renal vein).

⚠️ Risk Factors

Cryptorchidism (esp. abdominal testis; risk ↓ with early orchiopexy).
Personal/family history of testicular cancer.
Testicular feminisation, Klinefelter’s syndrome.
Caucasian men at higher risk.

🆚 Quick Comparison: Seminoma vs Non-Seminoma

Seminomas: Spread later, highly radiosensitive, better prognosis, typically affect older men (30–50).
NSGCTs: Spread earlier (often haematogenous), less radiosensitive, worse prognosis, affect younger men (15–35).

👨‍⚕️ Clinical Features

Painless, firm intratesticular lump (must always → testicular USS in 20–40 y/o men).
Scrotal heaviness or dull ache.
Gynaecomastia from ↑ β-hCG (esp. choriocarcinoma, seminoma with syncytiotrophoblasts).
Metastatic features: back pain (retroperitoneal nodes), cough/haemoptysis (lung mets), neuro symptoms (brain mets).

🔍 Investigations

FBC, U&E, LFTs, calcium, ALP.
Urine pregnancy test (β-hCG positive in many cases).
Tumour markers:
- LDH – elevated in bulk disease (prognostic marker).
- AFP – never raised in seminoma; ↑ in NSGCTs (esp. yolk sac, embryonal).
- β-hCG – raised in choriocarcinoma, some NSGCTs, and ~10% seminomas.
Imaging: Scrotal USS (first-line), CXR (look for cannonball mets), CT chest/abdomen/pelvis (staging).
❌ Never biopsy percutaneously → risk of tumour seeding.

🧪 Histological Types

Germ cell tumours (95%): Seminoma, Embryonal carcinoma, Yolk sac tumour, Choriocarcinoma, Teratoma, Mixed GCTs.
Non–germ cell (rare): Leydig, Sertoli, granulosa, gonadoblastoma, stromal tumours, lymphoma.

📊 Staging

Stage I: Confined to testis/cord.
Stage II: Retroperitoneal node involvement (below diaphragm).
Stage III: Distant metastases or supradiaphragmatic nodes.

💉 Treatment

Urgent 2WW referral for any painless testicular enlargement or change in consistency.
Radical inguinal orchidectomy (RIO): First-line in all suspected cases.
Seminoma: Orchidectomy ± retroperitoneal radiotherapy (Stage I–II). Very radiosensitive. Chemotherapy (BEP) in advanced disease.
Non-Seminoma: Orchidectomy + chemotherapy (BEP: Bleomycin, Etoposide, Cisplatin). Early RPLND in selected cases. Less radiosensitive.
Prognostic factors (poor prognosis NSGCT): AFP >10,000, HCG >50,000, LDH >10× ULN, mediastinal primary, non-pulmonary visceral mets.

📑 Summary Table

Feature	Seminoma	Non-Seminoma
Typical Age	30–50	15–35
Tumour Markers	β-hCG ↑ (10–20%), AFP normal	AFP ↑, β-hCG ↑, LDH ↑
Spread	Lymphatic (late)	Early haematogenous (lung, liver)
Prognosis	Excellent (>90% cure)	Variable, depends on stage/type
Radiotherapy	Highly sensitive	Resistant

📌 Less Common Tumours

Type	Examples	Notes
Mixed GCT	Seminoma + NSGCT	Behaves like NSGCT → treat accordingly
Stromal	Leydig, Sertoli	May secrete hormones → gynaecomastia, precocious puberty
Secondary	Lymphoma, metastatic deposits	Commonest >60 y/o; bilateral possible

📚 References

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Testicular Cancer