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Testicular Tumours

A mass that is part of the testis, and solid, is likely to be a tumour.

Table T1Comparison of the common testicular cancers
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Table T1 Comparison of the common testicular cancers

Seminoma

Non-seminoma (NSGCT)

Typical age

30–40 yrs

<35 yrs (20–30)

Incidence

40%

60%

Growth rate

Slow

Rapid

Nature

Solid

Mixed—solid + cystic

Stage at presentation

90%—stage 1

60%—stage 1

Tumour markers

αFP

Never

Common

β-HCG

Occasional

Common

Treatment

Inguinal orchidectomy + radiotherapy

  • Stage 1: orchidectomy

  • Relapse: chemotherapy

Sensitive to chemotherapy

+ ++

+ ++

Sensitive to radiotherapy

++ +

±

Prognosis

  • Stage 1: 99% 5-yr survival

  • Overall: >85%

  • Stage 1: 93% cure by surgery

  • Otherwise varies

Clinical features (general)

  • Young men 15–40 yrs

  • Painless lump in body of testis (commonest feature)

  • Loss of testicular sensation

  • Associated presentations (may mask tumour) (e.g. hydrocele, epididymo-orchiditis)

Golden rules

  • All solid scrotal lumps are malignant until proved otherwise and must be surgically explored.

  • Beware of hydroceles in young adults.

  • Investigate with US.

  • Avoid scrotal needling because of risk of tumour implantation in scrotal wall. For surgery, orchidectomy is through an inguinal incision.

Prognosis is good for most testicular tumours with 5-yr cure rates of 90–95%. Refer early to specialist centre.

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