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Testicular cancer: Difference between revisions
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<section begin="pathology" />'''Testicular cancer''' is most frequent in young males. It is the most common tumor in men in the 15 – 35 age group. There are three age peaks where testicular cancer is most common: | <section begin="oncology" /><section begin="pathology" />'''Testicular cancer''' is most frequent in young males. It is the most common tumor in men in the 15 – 35 age group. There are three age peaks where testicular cancer is most common: | ||
* 15 – 35 years (the most common age group) | * 15 – 35 years (the most common age group) | ||
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Germ cell tumors account for 95% of all testicular tumors. It’s very common (in 60% of cases) for germ cell tumors to contain more than one histological subtype. These are called ''mixed germ cell tumors''. The remaining 40% of cases are ''pure germ cell tumors'' and contain only one histological subtype. | Germ cell tumors account for 95% of all testicular tumors. It’s very common (in 60% of cases) for germ cell tumors to contain more than one histological subtype. These are called ''mixed germ cell tumors''. The remaining 40% of cases are ''pure germ cell tumors'' and contain only one histological subtype. | ||
Most germ cell tumor develop from a precancerous lesion called ''germ cell neoplasia in situ'' (GCNIS). This precancerous lesion is virtually always present together with the mature GCNIS-derived germ cell tumor when examined histologically. This lesion has a 50% chance of progressing into cancer within 5 years. | Most germ cell tumor develop from a precancerous lesion called ''germ cell neoplasia in situ'' (GCNIS). This precancerous lesion is virtually always present together with the mature GCNIS-derived germ cell tumor when examined histologically. This lesion has a 50% chance of progressing into cancer within 5 years.<section end="oncology" /> | ||
Isochromosome 12p or extra copies of 12p is seen in almost all germ cell tumors. | Isochromosome 12p or extra copies of 12p is seen in almost all germ cell tumors. | ||
<section begin="oncology" /> | |||
==== GCNIS-derived germ cell tumours ==== | ==== GCNIS-derived germ cell tumours ==== | ||
Seminoma is the most common pure testicular germ cell tumor. It most frequently occurs in patients in their 40s. Seminomas grow slowly and rarely metastasize, and therefore have a better prognosis than non-seminomas. It also has a good radiosensitivity, meaning that it’s highly treatable by irradiation. Seminomas are homogenous masses with small foci of haemorrhage or necrosis. Some cases of seminoma can produce hCG. | Seminoma is the most common pure testicular germ cell tumor. It most frequently occurs in patients in their 40s. Seminomas grow slowly and rarely metastasize, and therefore have a better prognosis than non-seminomas. It also has a good radiosensitivity, meaning that it’s highly treatable by irradiation. Seminomas are homogenous masses with small foci of haemorrhage or necrosis. Some cases of seminoma can produce hCG.<section end="oncology" /> | ||
Non-seminomas don’t respond as well to treatment as seminomas, and they metastasize earlier. | Non-seminomas don’t respond as well to treatment as seminomas, and they metastasize earlier. | ||
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The prepubertal teratoma is the second most common testicular tumor in children. Unlike most germ cell tumors it does not have isochromosome 12p. Contrary to the name it may also occur in adults, where it accounts for 20% of all teratomas. Prepubertal teratoma is benign, unlike the postpubertal type. | The prepubertal teratoma is the second most common testicular tumor in children. Unlike most germ cell tumors it does not have isochromosome 12p. Contrary to the name it may also occur in adults, where it accounts for 20% of all teratomas. Prepubertal teratoma is benign, unlike the postpubertal type. | ||
<section begin="oncology" /> | |||
=== Sex cord stromal tumours === | === Sex cord stromal tumours === | ||
These tumors account for 5% of all testicular tumors in adults, but they are much more frequent in childhood. These tumors arise from Leydig cells, Sertoli cells or granulosa cells. They are usually benign. | These tumors account for 5% of all testicular tumors in adults, but they are much more frequent in childhood. These tumors arise from Leydig cells, Sertoli cells or granulosa cells. They are usually benign.<section end="oncology" /> | ||
Leydig cell tumors may produce testosterone, which can cause early puberty in children. Occasionally they can cause symptoms of femininization as well. | Leydig cell tumors may produce testosterone, which can cause early puberty in children. Occasionally they can cause symptoms of femininization as well. | ||
<section begin="oncology" /> | |||
=== Lymphoma === | === Lymphoma === | ||
Lymphomas may occur in the testes as well, most frequently as [[diffuse large B-cell lymphoma]] (DLBCL). These are the most frequent testicular tumors in men older than 60. | Lymphomas may occur in the testes as well, most frequently as [[diffuse large B-cell lymphoma]] (DLBCL). These are the most frequent testicular tumors in men older than 60.<section end="oncology" /> | ||
A summary of the different histological types of testicular cancer can be found in the table below. | A summary of the different histological types of testicular cancer can be found in the table below. | ||
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|Usually DLBCL | |Usually DLBCL | ||
|} | |} | ||
<section begin="oncology" /> | |||
== Clinical features == | == Clinical features == | ||
Testicular tumors usually present as incidentally discovered firm, painless masses on the testis. Unlike hydroceles, these masses cannot be transilluminated. | Testicular tumors usually present as incidentally discovered firm, painless masses on the testis. Unlike hydroceles, these masses cannot be transilluminated. | ||
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=== Radiotherapy === | === Radiotherapy === | ||
Seminomas are very radiosensitive, whereas non-seminomas are only moderately radiosensitive. For this reason, radiotherapy is mostly only used for seminomas. Radiotherapy is less and less used nowadays in favour of chemotherapy. | Seminomas are very radiosensitive, whereas non-seminomas are only moderately radiosensitive. For this reason, radiotherapy is mostly only used for seminomas. Radiotherapy is less and less used nowadays in favour of chemotherapy.<section end="oncology" /> | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||