Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Abstract

Testicular cancer is relatively uncommon and accounts for ,1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nervesparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with .50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.

<p>Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa</p>

“…3 The global incidence has been rising steadily over the past decade. 4 The highest incidence of TC was found in Norway (11.8/100 000) and lower in India (0.5 per 100 000) and Thailand (0.4/100 000). 5 The exact incidence of testicular in sub-Saharan Africa is unknown but the incidence is lowest in Africa generally is estimated to range from (0.3-0.6/100 000).…”

“…Proper counseling about the possibility of infertility, testicular prothesis and sperm banking should be considered for patients with pathology of the contralateral testes. [1][2][3][4] A trans-scrotal ultrasound with doppler is recommended for all patients with unilateral or bilateral scrotal mass. [1][2][3][4]8 A radical inguinal orchidectomy is the standard initial management of suspicious testicular tumor and provides specimen for histological diagnosis.…”

“…Evidence has shown that family history of testicular cancer in first degree relative and the presence of contralateral TC/Germ Cell Neoplasia in Situ (GCNIS) may increase the risk of testicular tumors. [1][2][3][4][5][6][7] The predominant histological type is Germ Cell Tumor (90-95%) and 1-2% are found to be bilateral at diagnosis. Germ cell tumor are classified as either Seminoma, non-seminoma, teratoma and mixed tumors with the latter being considered as non-seminomas.…”

“…Alpha-Feto Protein (AFP) is produced by both embryonal carcinoma and yolk sac tumors. 1,4 Choriocarcinoma and pure seminoma do not produce AFP; therefore, any pure seminoma with elevated AFP is considered a NSGCT. Beta-Human Chorionic Gonadotropin (Beta-HCG) are produced by both pure seminoma and NSGCT.…”

“…Though LDH is non-specific, it is generally used for prognostic assessment of germ cell tumor at diagnosis and risk stratification of patient with metastatic non-seminomatous germ cell tumor starting chemotherapy. 1,4 The Lactate dehydrogenase-1 (LDH-1) isoenzyme is the most frequently elevated for germ cell testicular tumor. 1 The prognosis of testicular tumor is good with remarkable chemosensitivity to cisplatin-based regimen.…”