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INTRODUCTION

Epidemiology

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Epidemiology
Incidence:

9610 estimated new cases for 2020 in the United States

5.9 per 100,000 males per year

Most common malignancy in males ages 15–39

Deaths: Estimated 440 in 2020
Median age: 33 years

American Cancer Society Facts and Figures 2020: Special Section: Cancer in Adolescents and Young Adults

Siegel RL et al. CA Cancer J Clin 2020;70:7–30

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed in 2020]

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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 LAG et al (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988–2001. Bethesda, MD: National Cancer Institute; 2007.

Bosl G et al. In Devita V et al (editors). 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. Derived from germ cell neoplasia in situ (GCNIS)

    1. Seminoma

    2. Nonseminoma

      • i) Embryonal carcinoma

      • ii) Trophoblastic tumor

        • – Choriocarcinoma

        • – Other trophoblastic tumors

      • iii) Yolk-sac tumor, postpubertal type

      • iv) Teratoma, postpubertal type

        • – Teratoma with somatic malignancy

  2. Not derived from GCNIS

    1. Spermatocytic tumor

    2. Yolk-sac tumor, prepubertal type

    3. Teratoma, prepubertal type

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 tumor

    4. Tumors in the fibroma-thecoma group

    5. Mixed and unclassified sex-cord stromal tumors

  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

Moch H et al. World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. Lyon: IARC Press; 2016

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

Nonseminoma: CT A/P if >4 weeks since prior; CT chest if not previously performed

Seminoma: CT A/P and CXR if >4 weeks since prior

Scrotal ultrasound Bone scan or brain MRI, only if clinically indicated; sperm banking should ...

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