|
Table of Contents Purpose of This PDQ Summary
Summary of Evidence
Significance
Evidence of Benefit
Get More Information From NCI
Changes To This Summary (04/03/2008)
Questions or Comments About This Summary
More Information
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about testicular cancer screening. This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board.
Information about the following is included in this summary:
- Testicular cancer incidence and mortality statistics and information about testicular cancer risk factors.
- Benefits and harms of testicular cancer screening.
This summary is intended as a resource to inform clinicians and other health professionals about testicular cancer screening. The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in reporting the evidence of benefit and potential harms associated with screening. It does not provide formal guidelines or recommendations for making health care decisions. Information in this summary should not be used as a basis for reimbursement determinations.
This summary is also available in a patient version, which is written in less technical language.
Back to Top Summary of Evidence
Note: Separate PDQ summaries on Testicular Cancer Treatment and Levels of Evidence for Cancer Screening and Prevention Studies are also available.
Benefits
Based on fair evidence, screening for testicular cancer would not result in an appreciable decrease in mortality, in part because therapy at each stage is so effective.
Harms
Based on fair evidence, screening for testicular cancer would result in unnecessary diagnostic procedures with attendant morbidity.
Description of the Evidence
-
Study Design: Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
-
Internal Validity: Not applicable.
-
Consistency: Not applicable.
-
Direction and Magnitude of Effect: Fair evidence of no reduction in mortality; good evidence for rare but serious harms.
Back to Top Significance
Incidence and Mortality
It is estimated that 8,090 new cases of testicular cancer will be diagnosed in men, and 380 men will die of this disease in the United States in 2008.[1] Testicular cancer is the most common malignancy in men aged 15 to 35 years. It accounts for approximately 1% of all cancers in men. Worldwide, testicular cancer has more than doubled in the last 40 years. Incidence varies considerably in different geographical areas, being highest in Scandinavia and Switzerland; intermediate in the United States, Australia, and the United Kingdom; and lowest in Asia and Africa. It also varies according to ethnic groups, with a much higher rate among whites than blacks in the American population.[2] An annual increase of 3% is reported for Caucasian populations.[3] Despite the increase in observed incidence, there has been a dramatic decrease in mortality as a result of effective treatments.
Germ cell tumors (GCT) of the testis constitute 94% of testicular tumors and include five basic cell types: seminoma, embryonal carcinoma, yolk sac tumor, teratoma, and choriocarcinoma. Sixty percent of GCT are seminomas; the remainder are nonseminomatous germ cell tumors. Almost half of all germ cell tumors contain more than one of the five cell types.
Three subtypes of pure seminomas have been described: classic, anaplastic, and spermatocytic. Classic seminoma accounts for 80% to 85% of all seminomas and occurs most commonly in men aged 30 to 50 years. Anaplastic seminoma accounts for 5% to 10% of all seminomas and has an age distribution similar to that of the typical subtype. A number of features suggest that anaplastic seminoma is a more aggressive and potentially more lethal variant of typical seminoma. These characteristics include greater mitotic activity, higher rate of local invasion, increased rate of metastatic spread, and higher rate of tumor marker (human chorionic gonadotropin beta, or beta hCG) production. Spermatocytic seminoma accounts for 2% to 12% of all seminomas, and nearly half occur in men older than 50 years. The cells closely resemble different phases of maturing spermatogonia. The metastatic potential of this tumor is extremely low, and the prognosis is favorable.[4]
Risk Factors
Unlike most other cancers, testicular cancer is generally found in young men.[5] In
white men, testicular cancer is the most common cancer from age 20 years to age 34 years, the
second most common from age 35 years to age 39 years, and the third most common from
age 15 years to age 19 years. This type of cancer is 4.5 times more common among
white men than black men,[6] with intermediate incidence rates for Hispanics,
American Indians, and Asians. High-risk groups exist. Males with
cryptorchidism have 3 to 17 times the average risk. Approximately 7% to 10% of patients with testicular tumors have a history of cryptorchidism.[4,7] Orchiopexy may not prevent cancer in these children but allows clinical surveillance of patients with a previously impalpable gonad. There is also an increased
risk in males with gonadal dysgenesis and Klinefelter syndrome.[8] Men with
a family history of testicular cancer may be at a higher risk of this
disease.[9] A history of testicular cancer is associated with a higher risk of
a contralateral tumor.[4,7]
Although not consistently found to confer a higher risk, infertility, testicular atrophy, twinship, or
abnormal semen parameters have been associated with a higher risk of testis
cancer, but the evidence is weak.[7,10]
An additional risk factor for the development of testicular cancer is the presence of carcinoma in situ (CIS), also called intratubular germ cell neoplasia. Testicular CIS appears to develop from fetal gonocytes and is characterized histologically by seminiferous tubules containing only Sertoli cells and malignant-appearing germ cells.
If encountered in the
contralateral testis, CIS is associated with the development of contralateral
testicular cancer in 50% of patients at 5 years of follow-up.[11] CIS will be found in approximately 5% of contralateral testes (approximately
the same rate as cryptorchid testes).[12]
The association of testicular microlithiasis with testicular cancer is still of questionable clinical significance.[13,14]
Approximately 60% of testicular cancers are localized, 24% are regional, and 14%
are distant stage at diagnosis. Although there has been no appreciable change in the stage distribution at
diagnosis, advances in treatment have been associated with a 60% decrease in
mortality. Testicular cancer is so curable even at advanced stages and there
are so few cases that it would be virtually impossible to document a decrease
in mortality associated with screening.
Treatment options for CIS include observation, radiation therapy, chemotherapy, and orchiectomy. Although low-dose radiation therapy can preserve Leydig cell function and prevent germ-cell tumor development, a conservative approach of observation may also be warranted. Individuals at high risk (e.g., cryptorchidism, atrophic testis, and intersex conditions) require close observation.
Testicular cancer survivors are at an
increased risk of solid tumors for at least 35 years after treatment.[15]
There is a low cumulative risk of metachronous contralateral testicular
cancer and a favorable overall survival of patients diagnosed with
metachronous contralateral testicular cancer.[16]
References
-
American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008.
-
Huyghe E, Matsuda T, Thonneau P: Increasing incidence of testicular cancer worldwide: a review. J Urol 170 (1): 5-11, 2003.
[PUBMED Abstract]
-
Horwich A, Shipley J, Huddart R: Testicular germ-cell cancer. Lancet 367 (9512): 754-65, 2006.
[PUBMED Abstract]
-
Richie JP, Steele GS: Neoplasms of the testis. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Philadelphia: Saunders, 2002, pp 2876-2910.
-
Ries LA, Kosary CL, Hankey BF, et al., eds.: SEER Cancer Statistics Review 1973-1995. Bethesda, Md: National Cancer Institute, 1998.
-
Moul JW, Schanne FJ, Thompson IM, et al.: Testicular cancer in blacks. A multicenter experience. Cancer 73 (2): 388-93, 1994.
[PUBMED Abstract]
-
Dieckmann KP, Pichlmeier U: Clinical epidemiology of testicular germ cell tumors. World J Urol 22 (1): 2-14, 2004.
[PUBMED Abstract]
-
Henderson BE, Benton B, Jing J, et al.: Risk factors for cancer of the testis in young men. Int J Cancer 23 (5): 598-602, 1979.
[PUBMED Abstract]
-
Dieckmann KP, Pichlmeier U: The prevalence of familial testicular cancer: an analysis of two patient populations and a review of the literature. Cancer 80 (10): 1954-60, 1997.
[PUBMED Abstract]
-
Jacobsen R, Bostofte E, Engholm G, et al.: Risk of testicular cancer in men with abnormal semen characteristics: cohort study. BMJ 321 (7264): 789-92, 2000.
[PUBMED Abstract]
-
Jørgensen N, Müller J, Giwercman A, et al.: Clinical and biological significance of carcinoma in situ of the testis. Cancer Surv 9 (2): 287-302, 1990.
[PUBMED Abstract]
-
Dieckmann KP, Loy V: Prevalence of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell neoplasms. J Clin Oncol 14 (12): 3126-32, 1996.
[PUBMED Abstract]
-
Holm M, Hoei-Hansen CE, Rajpert-De Meyts E, et al.: Increased risk of carcinoma in situ in patients with testicular germ cell cancer with ultrasonic microlithiasis in the contralateral testicle. J Urol 170 (4 Pt 1): 1163-7, 2003.
[PUBMED Abstract]
-
Rowland RG: Editorial: testicular malignancies--high chance of cure-continuing opportunities to refine treatment. J Urol 170 (4 Pt 1): 1168, 2003.
[PUBMED Abstract]
-
Travis LB, Fosså SD, Schonfeld SJ, et al.: Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 97 (18): 1354-65, 2005.
[PUBMED Abstract]
-
Fosså SD, Chen J, Schonfeld SJ, et al.: Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst 97 (14): 1056-66, 2005.
[PUBMED Abstract]
Back to Top Evidence of Benefit
Most testicular cancers are first detected by the patient, either
unintentionally or by self-examination. Some are discovered by routine
physical examination. However, no studies have been done to determine the
effectiveness of testicular self-examination or clinical testicular examination
in reducing mortality from testicular cancer.
The benefit of testicular self-examination is unknown.
Screening would be very unlikely to decrease mortality substantially because therapy is so effective, even for advanced stages of disease. However, early
detection may have a practical impact on therapy. There is an increase in both
the number of courses of chemotherapy and the extent of surgery required for
treatment of advanced disease that results in higher morbidity. Patients
diagnosed with localized disease require less treatment and have lower
morbidity.[1]
References
-
Sagalowsky AI: Expectant management of stage A nonseminomatous testicular tumors. In: Ratiff TL, Catalona WJ, eds.: Genitourinary Cancer. Boston: Martinus Nijhoff, 1987, pp 225-237.
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes To This Summary (04/03/2008)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Significance
Updated incidence and mortality estimates for 2008 (cited American Cancer Society as reference 1).
Back to Top Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Back to Top More Information
About PDQ
Additional PDQ Summaries
Important:
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Back to Top |
