Testicular cancer natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2],Rim Halaby, M.D. [3] Shanshan Cen, M.D. [4]

Prognosis of testicular cancer is generally good, and the 5-year survival rate is approximately 96.6% (2004-2010). Common complications of testicular cancer include metastasis, bleeding, infection, and infertility.

• Seminoma tends to occur in middle aged people.
• Rarely metastasize.^[1]
• Affects people in their 15 and 35 years old

• Median age is 30 years old^[1]
• Has most of the component of mixed non seminoma germ tumor^[1]
• Tend to metastasize early to lungs, retroperitoneum, and liver^[2]

• Patient presents with early symptoms if there are metastatic lesions.^[3]
• Early metastasis through hematogenous route
• Tends to metastasize to lungs, brain, liver, peritoneum, and others.
• Affects most male patients in the second and third decade of their life.^[4]

• Mostly seen in children less than 2 years old^[5]
• Patients are usually asymptomatic at onset^[6]
• Tends to have elevated alpha fetoproteins (AFP)

• Seen in old men
• Barely metastasize^[7]

• Seen mostly in any age
• Benign in boys aged 5 to 10 years old and malignant in adults aged 30 to 60 years old^[8][9]
• It metastasizes in the regional lymph nodes such as iliac, inguinal and retroperitonial nodes^[10]

• It affects both infants and older adults
• Malignancy is seen in infants in presence of metastasis^[9]
• Sertoli cell tumor is associated with Peutz-Jeghers syndrome and Carney complex.
• large cell calcifying sertoli cell tumor is associated with Carney’s complex (syndrome of myxoma, spotty pigmentation and endocrine overactivity).^[11][12]

• It is rare type of testicular cancer.
• Seen mostly in the ovary

Adult type:

• It rarely metastasizes.
• Seen in the 4th decade of life.^[13]

Juvenile type

• It is seen mostly in infants.^[14]
• It is mostly benign
• It has an underlined association with sex chromosome abnormalities, ambiguous genitalia, and ipsilateral cryptorchidism.^[15]

Common complications of testicular cancer include:

• Metastasis

• Abdomen
• Lungs
• Retroperitoneal area
• Brain

• Post-surgery complications

• Bleeding
• Infection
• Infertility

• Between 2004 and 2010, the 5-year relative survival of patients with testicular cancer was 96.6%.^[16]

• When stratified by age, the 5-year relative survival of patients with testicular cancer was 95.4% and 86.4% for patients <65 and ≥ 65 years of age respectively.^[16]

• The survival of patients with testicular cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of testicular cancer:^[16]

• Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of testicular cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.^[16]

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