Testicular cancers are the most common malignancy in men between the ages of 20 and 34 years.
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Epidemiology
Testicular cancer is uncommon, accounting for less than 1% of all internal organ malignancies 2.
The commonest histology of the tumor varies with the age of affected individuals. Over 90% of all tumors of the testes are primary germ cell tumors, and as such young adults are the overall most frequently involved group:
1st decade: yolk sac tumor and testicular teratoma
2nd decade: choriocarcinoma
3rd decade: embryonal cell carcinoma
4th decade: seminoma
≥7th decade: lymphoma (usually non-Hodgkin lymphoma) and spermatocytic seminoma
Risk factors
family history
previous history of contralateral testicular tumor
See: risk factors for testicular germ cell tumors
Clinical presentation
In a large case-control study, the commonest symptoms associated with a diagnosis of testicular cancer were a swollen testis/scrotum and/or a lump 4.
Pathology
Classification
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primary tumor: 94% of all tumors
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testicular germ cell tumor: 90% of primary tumors
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testicular seminoma: 40% of germ cell tumors 1
classic
anaplastic
spermatocytic
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non-seminomatous germ cell tumor (NSGCT): 60% of germ cell tumors
testicular mixed germ cell tumor: (~33%, typically one or more NSGCTs and seminoma) 2
testicular teratoma (~4%)
testicular choriocarcinoma (~0.3%)
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testicular non-germ cell tumor: 10% of primary tumors
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secondary tumor: 6% of all tumors
secondary testicular lymphoma
Regional lymph nodes
The following retroperitoneal lymph node stations are considered regional:
aortocaval
para-aortic
paracaval
preaortic
precaval
retroaortic
retrocaval
The left and right testes have differing lymphatic drainage. The left testis primarily drains through the para-aortic lymph nodes. The right testis primarily drains through the aortocaval nodes.
Metastatic sites
Metastases from testicular tumors most commonly occur to the lymphatic system followed by lung, liver and bone, and other visceral sites.
Staging
Radiographic features
See the individual articles.
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