Clinical Review

Testicular germ cell tumours

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5526 (Published 24 September 2013) Cite this as: BMJ 2013;347:f5526

This article has a correction. Please see:

  1. Alan Horwich, professor of radiotherapy and honorary consultant in clinical oncology1,
  2. David Nicol, consultant urological surgeon2,
  3. Robert Huddart, reader in urological oncology and honorary consultant in clinical oncology1
  1. 1Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK
  2. 2Royal Marsden Hospital, London, UK
  1. Correspondence to: A Horwich, Division of Radiotherapy and Imaging, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK alan.horwich{at}icr.ac.uk

Summary points

  • Testicular germ cell cancers occur mainly in young men

  • Presentation is usually painless and the diagnosis can be confirmed by ultrasound

  • Inguinal orchidectomy may be sufficient treatment in those with no evidence of metastases

  • These tumours are sensitive to chemotherapy and radiotherapy, and even men with metastases are usually cured

  • Men cured of metastatic disease have an increased risk of cardiac events and of second non-germ cell cancers

Testicular germ cell cancer affects mainly young men, with 85% presenting between 15 and 44 years of age. The incidence of this disease is increasing—the lifetime risk for a man is now about one in 200 in the United Kingdom.1 Presentation is usually with a painless lump. If the tumour is diagnosed early, more than 95% of men are cured and treatment can be less intensive. Recent management changes include avoidance of radiotherapy, although cured patients still have increased risk of cardiac problems and second cancers. Some patients also experience chronic side effects of chemotherapy, such as neuropathy, hearing loss, renal impairment, and borderline hypogonadism. This article will review how testicular cancer presents, how it is diagnosed, and what treatments are available, including recent management changes to minimise toxicity.

Methods

We searched our personal archives of references relating to the epidemiology, diagnosis, and management of testicular germ cell cancers as well as the Cochrane Database for reviews or meta-analyses. We also reviewed guideline publications from the European Society of Medical Oncology and the European Germ Cell Cancer Collaborative Group.

What kinds of cancer arise in the testis?

This review covers germ cell cancers, which make up almost all testicular cancers seen in young men. Germ cell tumours are classified as pure seminomas or non-seminomas, which include variants such as embryonal carcinoma, teratocarcinoma, yolk sac tumour, choriocarcinoma, and teratoma. Tumours may contain one or more of these elements; those with both …

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