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Am Fam Physician. 2000;61(5):1469

Boys with cryptorchidism have a lifetime risk of testicular cancer that is nearly four times higher than the risk in the general population. The rate of early detection of these cancers would be substantially improved if groups at exceptionally high risk could be identified. Conversely, identifying boys with little or no increased risk could relieve family stress and allow for more efficient use of health care resources. Cortes and colleagues analyzed data from more than 1,200 cryptorchid boys to identify subgroups who later developed testicular cancer.

The authors correlated clinical and biopsy data from 1,249 boys who were treated for cryptorchidism between 1971 and 1998. During the follow-up period, eight testicular cancers developed in seven of the boys. Each cancer was associated with another significant abnormality. Four boys had abnormal external genitalia in addition to cryptorchidism, three cancers developed in intra-abdominal testes and two cancers occurred in boys with known abnormal karyotype. No cancer developed in boys without at least one of these conditions.

The authors calculate that the risk of testicular cancer is approximately 5 percent in cryptorchid boys with intra-abdominal testes, abnormal external genitalia or an abnormal karyotype. They recommend that a testicular biopsy be performed at the time of surgery in patients with these characteristics. Early biopsy may enable treatment for cancer to be initiated before invasion occurs.

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