TESTICULAR
TUMOURS
Diyana binti Kamarulzaman
INTRODUCTION
INTRODUCTION
Testicular cancer is not common: about 1 of every 250 males will
develop testicular cancer at some point during their lifetime.
The average age at the time of diagnosis of testicular cancer is about 33.
This is largely a disease of young and middle-aged men, but about 6% of
cases occur in children and teens, and about 8% occur in men over the
age of 55.
Because testicular cancer usually can be treated successfully, a man’s
lifetime risk of dying from this cancer is very low: about 1 in 5,000.
ANATOMY OF TESTES
Testicles (also called testes; a single testicle is called a testis) are part of the male reproductive system. The 2
organs are each normally a little smaller than a golf ball in adult males. They're held within a sac of skin called
the scrotum. The scrotum hangs under the base of the penis.
ANATOMY OF TESTES
EPIDEMIOLOGY OF TESTICULAR TUMOURS
The American Cancer Society’s estimates for testicular cancer in the US
for 2022 are:
• About 9,910 new cases of testicular cancer diagnosed
• About 460 deaths from testicular cancer
• The incidence rate of testicular cancer has been increasing in the US
and many other countries for several decades.
• The increase is mostly in seminomas.
According to Malaysia's National
Cancer Registry Report (2012 –
2016), testicular cancer accounted
for 1.2% of cancers in Malaysian
males.
INTRODUCTION
CLASSIFICATION OF TESTICULAR TUMOURS
GERM CELL TUMORS
More than 90% of cancers of the testicle start in cells known as germ cells. These are the cells that make
sperm. The main types of germ cell tumors (GCTs) in the testicles are seminomas and non-seminomas. Many
testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are
treated as non-seminomas because they grow and spread like non-seminomas.
SEMINOMAS : Tend to grow and spread more slowly than non-seminomas. The 2 main sub-types of these
tumors are classical (or typical) seminomas and spermatocytic seminomas.
• Classical seminoma: More than 95% of seminomas are classical. These usually occur in men between 25 -
45.
• Spermatocytic seminoma: A rare type of seminoma tends to occur in older men. (The average age is 65.)
Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than
classical seminomas.
CLASSIFICATION OF TESTICULAR TUMOURS
GERM CELL TUMORS
NON-SEMINOMAS : Embryonal Carcinoma, Yolk Sac Carcinoma, Choriocarcinoma & Teratoma.
• Usually occur in men between their late teens and early 30s.
• Most tumors are a mix of different types (sometimes with seminoma cells too), but this doesn’t change
the treatment of most non-seminoma cancers.
1. Embryonal carcinoma: Found in about 40% of testicular tumors, but pure embryonal carcinomas
occur only 3% to 4% of the time. Under microscope, it looks like tissues of very early embryos. This type
of non-seminoma tends to grow rapidly and spread outside the testicle.
• Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-
fetoprotein (AFP), as well as human chorionic gonadotropin (HCG).
2. Yolk sac carcinoma: These tumors look like the yolk sac of an early human embryo. Other names for
this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or
orchidoblastoma.
CLASSIFICATION OF TESTICULAR TUMOURS
3. Choriocarcinoma: This is a very rare and fast-growing type of testicular cancer in adults. Pure choriocarcinoma is likely to
spread rapidly to other parts of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are seen
with other types of non-seminoma cells in a mixed germ cell tumor. These mixed tumors tend to have a somewhat better
outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding.
4. Teratoma: Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a
developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). Pure teratomas of
the testicles are rare and do not increase AFP (alpha-fetoprotein) or HCG (human chorionic gonadotropin) levels. Most often,
teratomas are seen as parts of mixed germ cell tumor
• Mature teratomas : Formed by cells a lot like the cells of adult tissues. They rarely spread, can usually be cured
with surgery, but some recur after treatment.
• Immature teratomas : Less well-developed cancers with cells that look like those of an early embryo. This type
is more likely than a mature teratoma to invade nearby tissues, metastasize outside the testicle, and recur after
treatment.
• Teratomas with somatic type malignancy are very rare. These cancers have some areas that look like mature
teratomas but have other areas where the cells have become a type of cancer that normally develops outside the
testicle (such as a sarcoma, adenocarcinoma, or even leukemia)
SECONDARY TESTICULAR TUMOURS
These are not true testicular cancers – they don't start in the testicles. They're named and treated based on
where they started.
Lymphoma is the most common secondary testicular cancer. Testicular lymphoma is more common in men
older than 50 than primary testicular tumors. The outlook depends on the type and stage of lymphoma. The
usual treatment is surgical removal, followed by radiation and/or chemotherapy.
Leukemia : In boys with acute leukemia cells can sometimes form a tumor in the testicle that might
require treatment with radiation or surgery to remove the testicle.
Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles.
The prognosis for these cancers tends to be poor because these cancers have usually spread widely to other
organs as well. Treatment depends on the specific type of cancer.
DIAGNOSIS OF TESTICULAR TUMOURS
Most testicular cancers can be found at an early stage, when they're small and haven't spread. In some
men, early testicular cancers cause symptoms that lead them to seek medical attention. Most of the time a
lump on the testicle is the first symptom, or the testicle might be swollen or larger than normal. But some
testicular cancers might not cause symptoms until they've reached an advanced stage.
Physical Examination
•Bimanually examine scrotal contents and
compare with the normal contralateral testis
•Suspicious finding would be a firm, hard or
fixed area within the tunica albuginea
•Evaluation also includes abdominal palpation
for the presence of nodal disease or visceral
involvement, assessment of the supraclavicular
lymph nodes for adenopathy and the chest for
gynecomastia or thoracic involvement
DIAGNOSIS OF TESTICULAR TUMOURS
STAGING OF TESTICULAR TUMOURS
• May be clinical which includes physical
examination, evaluation of tumor markers and
imaging studies or pathologic which is defined by a
surgical procedure
• Determine post-orchiectomy serum levels of AFP,
hCG, and LDH
Stage I Tumour is confined to the testis and
epididymis
Stage II Nodal disease is present but is confined to
nodes below the diaphragm
Stage Nodes are present above the diaphragm
III
Stage Non Lymphatic metastatic disease(most
IV typically within the lungs)
MANAGEMENT OF TESTICULAR TUMOURS
Blood and Tumor Markers taken prior to
orchidectomy.
• There will be raised AFP around 50%-70% of
NSGCT’s
• Rise in hCG is seen in 40%-60% of NSGCTs and
around 30% of seminomas.
Ultrasound
• Confirm diagnosis
• Mandatory test in all suspected cases of testicular
tumor
CT scan.
• For staging
• Spread to any lymph nodes in the tummy(abdomen)
or chest area.
TREATMENT OF TESTICULAR TUMOURS
