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  • Print publication year: 2008
  • Online publication date: December 2009

20 - Testis

Summary

Introduction

The treatment of testicular cancer is a success story for oncology, with high cure rates even for patients with advanced metastatic disease. The management has changed little over the past 20 years, there is a high degree of consensus about treatment, and standard protocols are well developed. Nonetheless, patients with testicular cancer are best managed by specialised multidisciplinary teams.

Range of cancers

The range of testicular cancers is shown in Table 20.1.

Germ cell tumours

Incidence and epidemiology

The annual incidence of germ cell tumours in the UK is approximately 800 cases. Germ cell tumours are the most common malignant tumours that occur in men between the ages of 25 and 35; there is a second peak between the ages of 55 to 65 years. The reason for the rapid rise in incidence in the Western world is not known. Theories range from the impact of environmental oestrogens, related to oral contraceptive use, to the increased scrotal temperatures resulting from the use of disposable diapers in infancy.

Risk factors and aetiology

Both genetic and epigenetic factors probably affect the development of testicular cancer. There is certainly a genetic component, with around 2% of cases reporting an affected first-degree relative, and a ten-fold increased relative risk in a brother of an affected relative. However, a range of conditions associated with subnormal testicular development, such as testicular maldescent, Klinefelter's syndrome, Down's syndrome and subfertility, are also associated with a higher risk of cancer.

REFERENCES
Bokemeyer, C. and Schmoll, H. J. (1995). Treatment of testicular cancer and the development of secondary malignancies. J. Clin. Oncol., 13, 283–92.
Cullen, M. H., Stenning, S. P., Parkinson, M. C.et al. (1996). Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J. Clin. Oncol., 14, 1106–13.
Wit, M., Hartmann, M., Brenner, W.et al. (2006). [18F]-fluorodeoxyglucose-positron emission tomography in germ cell tumors following chemotherapy: results of the German multicenter trial. J. Clin. Oncol., 24, (18 Suppl.), 4521.
Fossa, S. D., Ous, S., Lien, H. H.et al. (1989). Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer. J. Urol., 141, 557–9.
Fossa, S. D., Horwich, A., Russell, J. M.et al. (1999). Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. J. Clin. Oncol., 17, 1146.
Harland, S. J., Cook, P. A., Fossa, S. D.et al. (1998). Intratubular germ cell neoplasia of the contralateral testis in testicular cancer: defining a high risk group. J. Urol., 160, 1353–7.
Hendry, W. F., A'Hern, R. P., Hetherington, J. W.et al. (1993). Para-aortic lymphadenectomy after chemotherapy for metastatic non-seminomatous germ cell tumours: prognostic value and therapeutic benefit. Br. J. Urol., 71, 208–13.
Horwich, A., Oliver, R. T., Wilkinson, P. M.et al. (2000). A medical research council randomized trial of single agent carboplatin versus etoposide and cisplatin for advanced metastatic seminoma. Br. J. Cancer, 83, 1623–9.
Huddart, R., O'Doherty, M., Padhani, A.et al. (2006). A prospective study of 18fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high risk clinical stage I (CS1) non-seminomatous germ cell cancer (non-seminomatous germ cell tumour): Medical Research Council study TE22. J. Clin. Oncol., 24, (18 Suppl.), 4520.
International Germ Cell Cancer Collaborative Group. (1997). International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J. Clin. Oncol., 15, 594–603.
Lampe, H., Horwich, A., Norman, A.et al. (1997). Fertility after chemotherapy for testicular germ cell cancers. J. Clin. Oncol., 15, 239–45.
Mead, G. M., Rustin, G. J., Stenning, S. P.et al. (2006). Medical Research Council trial of 2 versus 5 computed tomography scans in the surveillance of patients with stage I non-seminomatous germ cell tumours of the testis. J. Clin. Oncol., 24 (18 Suppl.), 4519.
Oliver, R. T., Mason, M., Mead, G. M.et al. (2005). Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet, 366, 293–300.
O'Sullivan, J. M., Huddart, R. A., Norman, A. R.et al. (2003). Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours. Ann. Oncol., 14, 91–6.
Patterson, H., Norman, A. R., Mitra, S. S.et al. (2001). Combination carboplatin and radiotherapy in the management of stage II testicular seminoma: comparison with radiotherapy treatment alone. Radiother. Oncol., 59, 5–11.
Shahidi, M., Norman, A. R., Dearnaley, D. P.et al. (2002). Late recurrences in 1263 men with testicular germ cell tumors. Multivariate analysis of risk factors and implications for management. Cancer, 95, 520–30.
Maase, H. (2001). Do we have a new standard of treatment for patients with seminoma stage IIA and stage IIB?Radiother. Oncol., 59, 1–3.
Williams, S. D., Birch, R., Einhorn, L. H.et al. (1987). Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N. Engl. J. Med., 316, 1435–40.