Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours. Germ cell tumours may essentially be divided into:

• seminomas
• non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma

Non-germ cell tumours include Leydig cell tumours and sarcomas.

The peak incidence for teratomas is 25 years and seminomas is 35 years. Risk factors include:

• infertility (increases risk by a factor of 3)
• cryptorchidism
• family history
• Klinefelter's syndrome
• mumps orchitis

Features

• a painless lump is the most common presenting symptom
• pain may also be present in a minority of men
• hydrocele
• gynaecomastia
  • this occurs due to an increased oestrogen:androgen ratio
  • germ-cell tumours → hCG → Leydig cell dysfunction → increases in both oestradiol and testosterone production, but rise in oestradiol is relatively greater than testosterone
  • leydig cell tumours → directly secrete more oestradiol and convert additional androgen precursors to oestrogens

Tumour markers

• germ cell tumours
  • seminomas: seminomas: hCG may be elevated in around 20%
  • non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
  • LDH is elevated in around 40% of germ cell tumours

Diagnosis

• ultrasound is first-line

Management