Testicular Cancer

Cancer of the testicles where sperm and male hormones are produced.

• Uncommon
• It tends to affect men from 20 years- 35 years old, where one does not expect to become ill.

• Testicular germ cell tumours is the most common type (95%):
  • Germ cells are the cells that develop into the embryo and later on become the cells that make up the reproductive system of men and women).
•  Most germ cell tumours occur in the testes or ovaries (gonads) or the lower back. When these tumours occur outside of the gonads, they are known as extragonadal tumours.
• Testicular germ cell tumors are generally split into two main subtypes:
  • Seminomas
  • Nonseminomatous germ cell tumors (NSGCTs). NSGCTs are sometimes referred to as nonseminomas.
  • Each type accounts for about 50% of testicular germ cell tumours.
  • There are several different types of nonseminomas including choriocarcinoma, yolk sac tumour, embryonal carcinoma, and teratoma.
• The 5% of people who develop a non-germ cell tumour may develop lymphoma affecting the testicles or a sex cord-stromal tumour, which is a tumour that arises from the supportive tissues of the testicles.

NORD

Measurement of AFP, beta-HCG, and LDH in patients in whom testicular cancer are suspected is mandatory before treatment, as is monitoring of these levels during and after treatment.

Serum AFP features are as follows:

• Secretion is restricted to nonseminoma.
• Reference adult concentration is < 10 ng/mL.
• Serum half-life is 4-5 days.
• Concentrations > 10,000 ng/mL are seen exclusively in germ cell tumor and hepatocellular carcinoma.
• Levels may be elevated in patients with hepatic dysfunction, hepatitis, cirrhosis, and drug or alcohol abuse.

Beta-hCG features are as follows:

• Increased levels of beta-hCG can be found in either seminoma or nonseminoma.
• Serum half-life is 18-36 hours.
• Patients with high levels of beta-hCG may experience nipple tenderness or gynecomastia.
• Serum beta-hCG concentrations above 10,000 mIU/mL are seen exclusively in germ cell tumors.
• Elevated levels may also be seen in patients with trophoblastic differentiation of a lung or gastric primary cancer or with hypogonadism.
• False-positive elevations may result from marijuana use.

LDH features are as follows:

• LDH has independent prognostic significance; increased levels reflect tumor burden, growth rate, and cellular proliferation.
• LDH is not a sensitive or specific indicator of disease recurrence and therefore is not a useful serum marker for posttreatment surveillance.

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