Testicular Cancer

Key points

• Testicular cancer is the most common solid malignancy in young adult men, with a peak incidence in roughly the 20–40-year age range; about 95% are germ-cell tumours .
• Germ-cell tumours are divided into seminoma and non-seminomatous germ-cell tumours (embryonal carcinoma, yolk-sac tumour, choriocarcinoma and teratoma). Non-germ-cell tumours include sex-cord/stromal tumours such as Leydig-cell tumours and other rare tumours. The old fixed peak ages should not be memorised as exact values.
• Infertility/subfertility is associated with testicular cancer and may coexist with underlying testicular dysgenesis; it is a risk association rather than a diagnostic criterion.
• Cryptorchidism is a major established risk factor for testicular germ-cell tumour.
• Family history , particularly an affected first-degree relative, increases risk.
• MRCP discriminator: young man + painless testicular mass → testicular cancer until proven otherwise; obtain urgent scrotal ultrasound and tumour markers (AFP, β-hCG, LDH) before definitive management.
• High-yield pathology: seminoma does not produce AFP; raised AFP indicates a non-seminomatous component.