Testis tumors include both germ cell tumors (seminomas, non-seminomatous cancers) as well as interstitial tumors that tend to be less aggressive and are often benign (Sertoli cell, Leydig cell tumors). Cancers from another site (lymph node cancers [lymphomas], prostate cancer, etc.) or benign tumors (adrenal rests) may also cause tumors within the testicle. Testis tumors are one of the most curable of all aggressive cancers. Higher cure rates are dependent on early detection and the evolution of highly effective chemotherapy treatment.

The cause of the progressive increase in the number of germ cell tumors (the most common and aggressive form of testis cancer) is not known. However, it is clear that this relatively rare tumor is being detected more often now than in the past.

Testis cancer is a highly curable disease entity when treated appropriately. For unknown reasons, testis cancer is becoming more prevalent in the U.S. and elsewhere. Just as self-examination for breast cancer is taught to young women, testicular self-examination should be encouraged among young men. Advanced medical techniques in diagnosis and treatment exist which effectively address this form of cancer with low risk of complications. As with many forms of cancer, early detection and treatment can significantly enhance prognosis.

New guidelines for evaluation of men and new treatment techniques that limit the side-effects seen after curative treatment (including infertility and sexual dysfunction) have been developed by the Physicians of the Department of Urology at Cornell. Newer evaluation approaches allow earlier detection of testicular cancers when they are more likely to be curable with limited treatment (e.g., in tumors associated with microlithiasis). New treatments developed at Cornell allow preservation of testicular tissue and function with effective treatment of smaller testicular tumors.

What's New in Testis Tumors

Evaluation of patients/Etiology(cause) of testis tumors

An article in the journal Cancer reported a 6- to 10-fold increase in the risk of developing a testicular tumor in the sons of fathers found to have a germ cell tumor (Hans & Peschel, 2000.) Although these results are based on a literature survey, the observations could lead to genetic analysis that could provide insight into genetic predisposition for developing testicular cancer and lead to earlier diagnosis. A comprehensive review of carcinoma-in-situ of the testis (more accurately refered to as intratubular germ cell neoplasia) was presented by Rorth et al (2000.) They noted that CIS invariably progresses to invasive tumor, so orchiectomy or radiation therapy is warranted. Chemotherapy will suppress but does not eradicate disease in many patients. Although risk groups include subfertile men, those with a history of cryptorchidism, atrophic testes, ambiguous genitalia and history of contralateral germ cell tumors, guidelines for biopsy are not well delineated.

The presence of elevated tumor markers in patients with germ cell tumors generally reflect active disease in these patients and warrant aggressive treatment. A series of 6 patients with modestly elevated, constant or spontaneously normalized tumor markers were noted to remain in remission in a report from Memorial Hospital (Morris & Bosl, 2000.) Careful repeat evaluation may be warranted with subsequent close surveillance in selected patients to avoid unnecessary chemotherapy.

Lymph node dissection

Rassweiler et al. (2000) reported on 34 attempted laparoscopic lymph node dissections performed for low-stage testis tumors. All complications (5) were noted in the first 10 cases, suggesting a rapid but potentially dangerous learning curve for this procedure. A comparison of primary RPLND compared to initial treatment with chemotherapy for clinical stage II A/B NSGCT was analyzed in a prospective multicenter trial from Germany and Austria (Weissbach et al., 2000.) They found that more patients had relapse after chemotherapy (11%) than primary RPLND (7%) and that 33% of chemotherapy patients required subsequent RPLND. Secondary RPLND was associated with a higher complication rate, suggesting that primary RPLND may be a better approach for these patients.

Fertility after treatment

Spermatogenic function was analyzed in two studies of men after orchiectomy or 2 cycles of chemotherapy for germ cell tumor. In 60 patients managed with surveillance, sperm counts improved in the first year after orchiectomy, especially when the FSH was initially normal. One year after orchiectomy, ? of these men had sperm concentration above 10 million sperm/cc (Jacobsen et al., 2001.) Of 59 patients with stage I NSGCT treated with chemotherapy, no significant effects of adjuvant chemotherapy on fertility or sexual activity were identified (Bohlen et al., 2001.)