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Chapter 35: Testicular Cancer

Darren R. Feldman; George J. Bosl

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    AMA Citation
    Feldman DR, Bosl GJ. Feldman D.R., Bosl G.J. Feldman, Darren R., and George J. Bosl.Testicular Cancer. In: Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al.eds. Hematology-Oncology Therapy, 2e New York, NY: McGraw-Hill; . http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126668321. Accessed February 17, 2019.
    MLA Citation
    Feldman DR, Bosl GJ. Feldman D.R., Bosl G.J. Feldman, Darren R., and George J. Bosl.. "Testicular Cancer." Hematology-Oncology Therapy, 2e Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al. New York, NY: McGraw-Hill, , http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126668321.

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INTRODUCTION

Epidemiology

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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)
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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

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Pathology
Germ Cell Tumors (95%) Non–Germ Cell Tumors (5%)

  1. Seminoma

    1. Classic

    2. Spermatocytic

  2. Nonseminoma

    1. Embryonal carcinoma

    2. Teratoma

      1. Teratoma (Mature or Immature)

      2. Teratoma with malignant transformation

    3. Choriocarcinoma

    4. Yolk sac (endodermal sinus) tumor

Note: Most common nonseminoma histology is a mixture of ≥2 histologies. Pure teratoma represents a fully malignant GCT

  1. Sex cord-stromal (gonadal stromal) tumors

    1. Leydig cell

    2. Sertoli cell tumor

    3. Granulosa cell

  2. Both germ cell and gonadal stromal elements

    1. Gonadoblastoma

  3. Adnexal and paratesticular tumors

    1. Mesothelioma

    2. Carcinoma of rete testis

  4. Miscellaneous neoplasms

    1. Carcinoid

    2. Lymphoma

    3. Sarcoma

    4. Other

Work-up

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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

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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 ...

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