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INTRODUCTION

Key Points

  • Testicular cancer is the most common malignancy among young men.

  • Although there is substantial geographical variation, the incidence of testicular cancer has increased worldwide.

  • More than 95% of patients with testicular cancer are cured by appropriate treatment.

TESTICULAR CANCER

Epidemiology

Testicular cancer is the most common malignancy among men 20 to 45 years. In adults, the vast majority (>95%) of testicular tumors are germ cell cancers (TGCC). The epidemiology of TGCC exhibits some striking trends:

  • The incidence of TGCC has increased worldwide; this increase in incidence has been most pronounced among men of European origin.

  • There is a substantial geographical variation in TGCC incidence. The incidence is the highest in Scandinavian countries, Denmark, and Norway; the incidence is 50% lower in Sweden and even lower in Finland.1 Even in Europe, there is considerable variation in the incidence of this malignancy; in most European countries, the incidence of TGCC does not reach the Danish or Norwegian levels of more than 10 annual cases per 100,000 men.

  • The incidence trends are more closely associated with the year of birth than with the time of diagnosis. Interestingly, a steady increase in TGCC incidence in early part of the twentieth century was interrupted by a significant drop among those born during World War II, followed by a postwar catchup in incidence.

TGCC includes a number of subtypes, which based on their histology and clinical behavior, have been merged into 2 main groups:

  • Seminomas represent a more homogeneous histological tumor type that occurs most frequently in younger men and rarely metastasizes outside the local, retroperitoneal lymph nodes.

  • Nonseminomas include a number of histological variants that occur typically at an older age than seminomas. Nonseminomatous tumors typically grow more rapidly and tend to metastasize.

Seminoma is the most common pure germ cell tumor of the testis, accounting for up to 60% of all TGCCs. Seminomas can occur either as a pure tumor or as a component of a mixed tumor that may also include elements of teratoma, embryonal carcinoma, and yolk sac tumors. The peak incidence is in the third decade of life for nonseminomas, and in the fourth decade for pure seminomas.

Etiology and Pathogenesis

Although the cause of TGCC remains unknown in a majority of cases, there is agreement that TGCC probably has a fetal origin and environmental and lifestyle-related factors are involved in the disease mechanism.

Both seminomas and nonseminomas originate from the germ cell neoplasia in situ (GCNIS), previously called carcinoma in situ (CIS).2 GCNIS is a condition in which the malignant cells are located within the seminiferous tubules, most commonly mixed with Sertoli cells but, in some cases, with normal germ cells. GCNIS exhibits many histological and molecular markers of early germ cells, and the available ...

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