Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Epidemiology Table Graphic Jump Location|Download (.pdf)|Print Incidence: 8,820 estimated new cases for 2014 in the United States 5.5 per 100,000 males per year Deaths: Estimated 380 in 2014 Median age: 33 years Siegel R et al. CA Cancer J Clin 2013;63:11–30 Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013) Table Graphic Jump Location|Download (.pdf)|Print Epidemiology Frequency of Stage at Presentation Seminoma Nonseminoma Stage I 85% 60% Stage II 10% 20% Stage III 5% 20% Frequency of IGCCCG Risk Groups at Diagnosis for Patients Requiring Chemotherapy IGCCCG Risk Group Seminoma Nonseminoma All Good 90% 56% 60% Intermediate 10% 28% 26% Poor N/A 16% 14% IGCCCG, International Germ Cell Cancer Collaborative Group; GCT germ cell tumor Biggs M, Schwartz S. “Cancer of the Testis.” In Ries SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988–2001. 2007:165–170 Bosl G et al. In Devita V, Lawrence T, Rosenberg S, eds. Cancer: Principles and Practice of Oncology. Philadelphia: Lippincott Williams and Wilkins, 2008:1463–1485 International Germ Cell Cancer Collaborative Group (IGCCCG). J Clin Oncol 1997;15:594–603 Siegel R et al. CA Cancer J Clin 2014;64:9–29 ++ Pathology Table Graphic Jump Location|Download (.pdf)|Print Pathology Germ Cell Tumors (95%) Non–Germ Cell Tumors (5%) Seminoma Classic Spermatocytic Nonseminoma Embryonal carcinoma Teratoma Teratoma (Mature or Immature) Teratoma with malignant transformation Choriocarcinoma Yolk sac (endodermal sinus) tumor Note: Most common nonseminoma histology is a mixture of ≥2 histologies. Pure teratoma represents a fully malignant GCT Sex cord-stromal (gonadal stromal) tumors Leydig cell Sertoli cell tumor Granulosa cell Both germ cell and gonadal stromal elements Gonadoblastoma Adnexal and paratesticular tumors Mesothelioma Carcinoma of rete testis Miscellaneous neoplasms Carcinoid Lymphoma Sarcoma Other ++ Work-up Table Graphic Jump Location|Download (.pdf)|Print Work-up Suspicious Testicular Mass (by History or Exam) Confirmed Testicular Mass (by Ultrasound) Seminoma or Nonseminoma (S/P Orchiectomy) History and physical STM if not yet done STM AFP, hCG, and LDH (serum tumor markers [STM]) CBC, complete metabolic profile CBC, complete metabolic profile CBC, complete metabolic profile CT A/P + either CXR or CT chest CT C/A/P if >4 weeks since prior Scrotal ultrasound Bone scan or MRI Brain, only if clinically indicated Bone scan or MRI Brain, only if clinically indicated Discussion of sperm banking if further treatment (surgery, chemotherapy, or XRT) is required ++ Staging Table Graphic Jump Location|Download (.pdf)|Print Staging T: Primary Tumor Staging pTx Primary tumor cannot be assessed pT0 No evidence of primary tumor pTis Intratubular germ cell neoplasia (testicular intraepithelial neoplasia) pT1 Tumor limited to testis and epididymis without lymphovascular invasion (LVI); tumor may invade tunica albuginea but not tunica vaginalis pT2 Tumor limited to the testis and epididymis with LVI or tumor extending through the tunica albuginea with involvement of the tunica vaginalis pT3 Tumor invades the spermatic cord with or without LVI pT4 Tumor ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth