Testicular germ cell tumours

Testicular germ cell cancer is mainly a disease of young men

• 85% cases are between the age of 15 and 44 years (1)
• life time risk of is around 1 in 200 in the UK (1)
• If diagnosed early, 95% of cases can be cured and treatment can be less intensive (1)
• between 90% and 95% of testicular cancers are germ cell tumors (GCTs) (2)
• mean age at diagnosis for testicular cancer is 33 years (2)

Germ cell tumours are broadly divided into:

• pure seminomas,
  • account for approximately 40% of tumours
    
    
• non-seminomas
  • account for approximately 60% tumours
  • include multiple cell types e.g. - embryonal cell carcinoma, choriocarcinioma, yolk sac tumour
  • clinically more aggressive (3)

Risk factors testicular germ cell tumours include (2):

• cryptorchidism
• family history of testicular cancer
• gonadal dysgenesis
• infertility
• cannabis use
• genetic conditions such as Klinefelter syndrome

Stage of germ cell testicular tumours at diagnosis (2):

• stage I (localized to the testicle) in 70% to 75% of patients
• stage II (metastatic only to the retroperitoneal lymph nodes) in 20%
• stage III (widely metastatic) in 10%.

Management principles:

• early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important in optimizing outcomes
• treatment is guided by histology, clinical staging, and risk classification

Prognosis

• 5-year survival rates are 99%, 92%, and 85% for stages I, II, and III, respectively (2)

Reference:

• (1) Horwich A et al. Testicular germ cell tumour. BMJ. 2013;347:6205
• (2) Singla N, Bagrodia A, Baraban E, Fankhauser CD, Ged YMA. Testicular Germ Cell Tumors: A Review. JAMA. Published online February 03, 2025.
• (3) Sohaib SA, Koh DM, Husband JE. The role of imaging in the diagnosis, staging, and management of testicular cancer. AJR Am J Roentgenol. 2008;191(2):387-95