Testicular Cancer: Diagnosis and Treatment

 

Am Fam Physician. 2018 Feb 15;97(4):261-268.

  Patient information: See related handout on testicular cancer.

Author disclosure: No relevant financial affiliations.

Testicular cancer is the most common solid tumor among males 15 to 34 years of age, with an estimated 8,850 new cases and 410 deaths during 2017 in the United States. With effective treatment, the overall five-year survival rate is 97%. Risk factors for testicular cancer include undescended testis (cryptorchidism), personal or family history of testicular cancer, age, ethnicity, and infertility. The U.S. Preventive Services Task Force recommends against routine screening in asymptomatic men. Men with symptoms should receive a complete history and physical examination. Scrotal ultrasonography is the preferred initial imaging study. If a solid intratesticular mass is discovered, orchiectomy is both diagnostic and therapeutic. Staging through chest radiography, chemistry panel, liver function tests, and tumor markers guides treatment. Active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy are treatment options following orchiectomy. For patients desiring future fertility, sperm banking should be discussed early in the course of treatment. Family physicians often play a role in the care of cancer survivors and should be familiar with monitoring for recurrence and future complications, including secondary malignant neoplasms, cardiovascular risk, and infertility and subfertility.

Testicular cancer is the most common solid tumor among males 15 to 34 years of age. The age-adjusted annual incidence in the United States is 5.6 cases per 100,000 persons, with a peak of 14.6 cases per 100,000 persons 30 to 34 years of age. Figure 1 includes incidence rates by age and ethnicity.1 In 2017, there were an estimated 8,850 new cases of testicular cancer and 410 deaths. Whites, Hispanics, and American Indian/Alaska Natives have the highest rates of testicular cancer.1 The incidence of testicular cancer has increased over the past several decades for unclear reasons. With effective treatment, the overall five-year survival rate is 97%.2

Table 1 presents an overview of the World Health Organization classification of testicular tumors, with prevalence of the most common histologic types.3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Routine screening for testicular cancer in asymptomatic men is not recommended.

C

18, 19, 21

Confirmation of an alternative diagnosis is required to exclude testicular cancer in patients with a scrotal mass.

C

2426

Scrotal ultrasonography is the preferred initial imaging study for evaluating a testicular mass.

C

2426

Active surveillance (orchiectomy without additional therapy) is a reasonable treatment option for stage I germ cell tumors with no risk factors for relapse.

B

2426, 33, 34, 37, 39

After primary treatment for testicular cancer, primary care physicians should routinely monitor patients for recurrence, secondary malignancy, infertility, cardiovascular disease, and other complications of chemotherapy and radiotherapy.

C

2426, 43, 4751, 5355

For patients desiring future fertility, sperm banking should be discussed early in the course of treatment.

C

2426, 47


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Routine screening for testicular cancer in asymptomatic men is not recommended.

C

18, 19, 21

Confirmation of an alternative diagnosis is required to exclude testicular cancer in patients with a scrotal mass.

C

2426

Scrotal ultrasonography is the preferred initial imaging study for evaluating a testicular mass.

C

2426

Active surveillance (orchiectomy without additional therapy) is a reasonable treatment option for stage I germ cell tumors with no risk factors for relapse.

B

2426, 33, 34, 37, 39

After primary treatment for testicular cancer, primary care physicians should routinely monitor patients for recurrence, secondary malignancy, infertility, cardiovascular disease, and other complications of chemotherapy and radiotherapy.

C

2426, 43, 4751, 5355

For patients desiring future fertility, sperm banking should be discussed early in the course of treatment.

C

2426, 47


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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FIGURE 1.

Annual incidence of testicular cancer in the United States.

Information from reference 1.


FIGURE 1.

Annual incidence

The Authors

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DREW C. BAIRD, MD, is the program director of the Family Medicine Residency Program at Carl R. Darnall Army Medical Center, Fort Hood, Tex....

GARRETT J. MEYERS, MD, is the associate program director of the Family Medicine Residency Program at Carl R. Darnall Army Medical Center.

JOCELYN S. HU, MD, is a family physician in Fort Polk, La. At the time the manuscript was written, she was chief resident at the Family Medicine Residency Program at Carl R. Darnall Army Medical Center.

Author disclosure: No relevant financial affiliations.

Address correspondence to Drew C. Baird, MD, Carl R. Darnall Army Medical Center, Bldg. 36065, Fort Hood, TX 76544 (e-mail: drew.c.baird.mil@mail.mil). Reprints are not available from the authors.

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