Managing testicular cancer

doi:10.1136/bmj.322.7302.1583

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DP Dearnaley, head of urology (davidd@icr.ac.uk),
RA Huddart, senior lecturer,
A Horwich, professor

Academic Unit of Clinical Oncology, Royal Marsden NHS Trust, Sutton SM2 5PT

Correspondence to: DP Dearnaley

Germ cell tumours of the testis are the commonest malignancy in men aged 20–40 years. Considerable therapeutic improvements in management—based on the cancer's responsiveness to chemotherapy that contains platinum—mean that over 95% of these patients can now expect to be cured.

Summary points

Testicular cancer is the most common cancer in younger men

The incidence has been increasing by 15-20% in successive five year periods

Clinical trials organised by the UK's Medical Research Council and other international groups have defined modern clinical practice

Cure rates of >95% can be achieved

Advanced and recurrent cancers should be treated by multidisciplinary teams in specialist centres

Methods

Much of the clinical management discussed in this review is based on the guidelines of the UK's Clinical Oncology Information Network, which were developed with the Scottish Intercollegiate Guidelines Network.1 These were based on a systematic review of clinical data including prospective phase III randomised trials performed internationally. The sections that discuss causes, follow up, and future developments reflect our research interests and personal experience.

Incidence and aetiology

Testicular germ cell tumours

Testicular germ cell tumours are uncommon cancers; they account for around 1% of all cancers in males. About 1400 new cases are diagnosed in the United Kingdom each year. Germ cell tumours have a unique epidemiological profile for a solid tumour. Their peak incidence occurs among men aged 25–35 years, and there is a distinctive geographical and racial variation. The highest incidence is among white men in northern Europe.

These factors suggest that both genetic and environmental factors are important in the development of testicular germ cell tumours. The age distribution at onset suggests that an initiating event occurs prenatally and that the tumour develops from adolescence. The overall incidence of testicular germ cell tumours has been steadily rising throughout the 20th century, with an increase of 15-20% being seen in …