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Testicular Cancer

  • Author: Kush Sachdeva, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
 
Updated: Jun 03, 2016
 

Background

Primary testicular tumors are the most common solid malignant tumor in men between the ages of 20 and 35 years in the United States. For unknown reasons, the incidence of this cancer—principally, testicular seminomas—increased during the last century. Over the past decade, the incidence of testicular cancer has risen approximately 1.2% per year, although the rate of increase has been slowing. However, the absolute mortality rate has been stable or decreasing; approximately 9,000 new cases have been diagnosed in United States every year, and only about 350 to 400 deaths have occurred annually.

The American Cancer Society (ACS) estimates that about 8720 new cases of testicular cancer will be diagnosed during 2016 in the United States.[1] The ACS estimates that 380 men will die of testicular cancer in 2016. The lifetime chance of developing testicular cancer is about one in 263 and the risk of dying is very low—about one in 5,000.[2]

In the past, metastatic testicular cancer was usually fatal, but advances in treatment, including high-dose chemotherapy and stem cell rescue, have considerably improved the prognosis. Indeed, testicular cancer is a bright spot in the oncological landscape and is now considered the model for the treatment of solid tumors.

Testicular cancers are very sensitive to chemotherapy and are curable even when metastatic. Cure rates for good-risk disease cure rates are 90-95%. However, patients cured of testicular cancer have approximately a 2% cumulative risk of developing a cancer in the opposite testicle during the 15 years after initial diagnosis. The risk of subsequent contralateral testis tumors appears to be higher in men whose primary tumor was a seminoma than in those with nonseminomatous primary tumors.[3]

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Pathophysiology

The cause of testicular cancer is not known. The characteristic genetic change found is an isochromosome of the short arm of chromosome 12 [i(12p)], which is often seen in sporadic cancers. This suggests that genes in this region are important in the development of germ cell tumors. A number of other genes that have a relatively weak effect are also involved in the development of testicular cancer.

That genetic factors have a role in the development of testicular cancer is shown by the fact that the risk for the disease is higher in first-degree relatives of cancer patients than in the general population. About 2% of testicular cancer patients report having an affected relative. Siblings are at particularly increased risk, with a relative risk of 8–10. For sons of affected men, the relative risk is 4–6.

Two models of testicular carcinoma in situ have been proposed. The first posits that fetal gonocytes whose development into spermatogonia is blocked may undergo abnormal cell division and then invasive growth mediated by postnatal and pubertal gonadotropin stimulation.

The second model postulates that the most likely target cell for transformation is the zygotene-pachytene spermatocyte. During this stage of germ cell development, aberrant chromatid exchange events associated with crossing over can occur. Normally, these cells are eliminated by apoptosis. On occasion, this crossing over may lead to increased 12p copy number and overexpression of the cyclin D2 gene (CCND2). The cell carrying this abnormality is relatively protected against apoptotic death because of the oncogenic effect of CCND2, leading to re-initiation of the cell cycle and genomic instability.

Malignant transformation of germ cells is the result of a multistep process of genetic changes. One of the earliest events is the increased copy number of 12p, either as 1 or more copies of i(12p) or as tandem duplications of chromosome arm 12p. This abnormality is found in occult carcinoma in situ lesions as well as more advanced disease. Further studies indicate that CCND2 is present at chromosome band 12p13 and that CCND2 is overexpressed in most germ cell tumors, including carcinoma in situ. Amplification of CCND2 activates cdk4/6, allowing the cell to progress through the G1-S checkpoint.

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Epidemiology

Frequency

United States

Testicular cancers are not a common malignancy. The American Cancer Society (ACS) estimates that about 8720 new cases of testicular cancer will be diagnosed during 2016 in the United States.[1] Most cases occur in young and middle-aged men; the median age at diagnosis is approximately 33 years.[2]

In the United States, the incidence increased by 100% from 1988 to 2001. Diagnoses of seminomas increased 124% during that period and diagnoses of nonseminomas increased by 64%. No significant increase occurred in the incidence of early-stage disease in proportion to all diagnoses in this population, indicating that the increase was not due to more widespread screening or earlier detection.[4] The rate of increase has slowed in recent years.[2]

According to Surveillance, Epidemiology, and End Results (SEER) data from 17 geographic areas, the age-adjusted annual incidence of testicular cancer from 2009–2013 was 5.7 per 100,000 men.[5] However, the incidence varies widely by race/ethnicity (see below).

International

Studies of testicular cancer in selected global populations from 1973-2007 have shown a clear trend towards an increased incidence in most populations evaluated.[6, 7] In recent years, however, rates have plateaued in some areas and even decreased in a few.[6]

Rates are highest in Northern Europe and in men descended from European populations—Northern European populations in particular. The incidence varies even in Northern Europe, however, with rates notably higher in Norway and Denmark than in Sweden and Finland.[7] In recent years, rates in Eastern European countries have risen rapidly, approaching those in Northern European countries. Rates are lowest in Asia and Africa and intermediate in Central and South America.[6]

Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor.[7]

Mortality/Morbidity

Testicular cancers are highly curable, even in patients with metastatic disease at diagnosis. The prognosis depends upon the histologic type of cancer (seminoma versus nonseminoma), stage, and other features such as tumor marker and type of metastatic disease.

Patients with seminomas that confer a good prognosis, which constiute about 90% of seminomas, have a 5-year survival of 86%; patients with good-prognosis nonseminomas (56% of nonseminomas) have a 5-year survival of 92%. With intermediate-prognosis cancers (28% of nonseminomas), 5-year survival is 72% with seminomas and 80% with nonseminomas. With poor-prognosis nonseminomas (about 16% of nonseminomas) 5-year survival is 48%.

Those survival data are based on patients treated between 1975 and 1990; more recent studies has shown much better survival with nonseminomatous germ cell tumors (NSGCT). Pooled 5-year survival estimates for NSGCT were 94% for good-prognosis, 83% for intermediate-prognosis, and 71% for poor-prognosis tumors.

Race

The incidence of testicular cancer is fivefold higher in whites than in African Americans; however, African Americans tend to present with higher-grade disease and have much worse prognosis than whites.[8] See the Table below.[5]

Table. Incidence of Testicular Cancer by Race (Open Table in a new window)

Incidence of Testicular Cancer by Race
Race/Ethnicity Annual rate per 100,000 men
All Races 5.7
White 6.7
Black 1.5
Asian/Pacific Islander 2.1
American Indian/Alaska Native 4.9
Hispanic 5.0

A review of data from the Surveillance, Epidemiology, and End Results Program found that in Hispanic whites ages 15 to 39 years the annual incidence of testicular germ cell tumors increased 58% between 1992 and 2010, from 7.18 to 11.34 cases per 100,000. By comparison, during that period the incidence in non-Hispanic white young adults increased 7%, from 12.41 to 13.22 cases per 100,000.[9]

Age

Testicular cancer can occur at any age but is most common between the ages of 15 and 35 years; 50% of cases occur in men 20-34 years old.[5] There is also secondary peak in incidence after age 60. Seminoma is rare in boys younger than 10 years of age but is the most common histologic type in men older than 60.

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Contributor Information and Disclosures
Author

Kush Sachdeva, MD Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Coauthor(s)

Brendan Curti, MD Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center

Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, Society for Immunotherapy of Cancer

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Prometheus Pharmaceuticals<br/>Received research grant from: Prometheus Pharmaceuticals.

Issam Makhoul, MD Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP Clinical Assistant Professor of Medicine, University of California, Davis, School of Medicine; Consultant, Sierra Hematology-Oncology Medical Center

Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Bagi RP Jana, MD Associate Professor of Medicine (Genitourinary Oncology), Division of Hematology and Oncology, University of Texas Medical Branch

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, SWOG, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Acknowledgements

The author and editors wish to thank Salah Almokadem, MD,  Assistant Professor of Medicine, Department of Medicine, Penn State Milton S Hershey Medical Center; and Charles J Ryan, MD, Assistant Clinical Professor, Department of Medicine, Division of Hematology and Oncology, University of California at San Francisco, for their contributions to previous versions of this article.

References
  1. American Cancer Society. Cancer Facts & Figures 2016. Available at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed: June 1, 2016.

  2. American Cancer Society. What are the key statistics about testicular cancer?. American Cancer Society. Available at http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-key-statistics. Accessed: June 1, 2016.

  3. Testicular Cancer Treatment. National Cancer Institute. Available at http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional/page1. February 17, 2016; Accessed: June 1, 2016.

  4. McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer. 2003 Jan 1. 97(1):63-70. [Medline].

  5. Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Testis Cancer. National Cancer Institute. Available at http://seer.cancer.gov/statfacts/html/testis.html. Accessed: June 1, 2016.

  6. Trabert B, Chen J, Devesa SS, Bray F, McGlynn KA. International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007. Andrology. 2014 Oct 20. [Medline].

  7. Chia VM, Quraishi SM, Devesa SS, Purdue MP, Cook MB, McGlynn KA. International trends in the incidence of testicular cancer, 1973-2002. Cancer Epidemiol Biomarkers Prev. 2010 May. 19(5):1151-9. [Medline]. [Full Text].

  8. McGlynn KA, Devesa SS, Graubard BI, Castle PE. Increasing incidence of testicular germ cell tumors among black men in the United States. J Clin Oncol. 2005 Aug 20. 23(24):5757-61. [Medline].

  9. Chien FL, Schwartz SM, Johnson RH. Increase in testicular germ cell tumor incidence among Hispanic adolescents and young adults in the United States. Cancer. 2014 Sep 1. 120(17):2728-34. [Medline].

  10. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007 May 3. 356(18):1835-41. [Medline].

  11. Travis LB, Fossa SD, Schonfeld SJ, McMaster ML, Lynch CF, Storm H. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst. 2005 Sep 21. 97(18):1354-65. [Medline].

  12. van Leeuwen FE, Stiggelbout AM, van den Belt-Dusebout AW, et al. Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol. 1993 Mar. 11(3):415-24. [Medline].

  13. Walsh TJ, Croughan MS, Schembri M, Chan JM, Turek PJ. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med. 2009 Feb 23. 169(4):351-6. [Medline].

  14. [Guideline] Testicular Cancer: Version 2.2016. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Accessed: June 2, 2016.

  15. Subik MK, Gordetsky J, Yao JL, di Sant'agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol. 2012 Mar 8. [Medline].

  16. American Joint Committee on Cancer. Testis. AJCC Cancer Staging Manual. 6th edition. New York: Springer Science Business Media LCC; 2006.

  17. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor- based staging system for metastatic germ cell cancers. J Clin Oncol. 1997 Feb. 15(2):594-603. [Medline].

  18. Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011 Apr. 22(4):808-14. [Medline].

  19. Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized Trials in 2466 Patients With Stage I Seminoma: Patterns of Relapse and Follow-up. J Natl Cancer Inst. 2011 Feb 2. 103(3):241-249. [Medline].

  20. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005 Jul 23-29. 366(9482):293-300. [Medline].

  21. Oliver RT, Mead GM, Fogarty PJ, Stenning SP, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. May 20 2008. 26 suppl:abstract 1. [Full Text].

  22. De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004 Mar 15. 22(6):1034-9. [Medline].

  23. Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014 Dec 1. 32(34):3817-23. [Medline].

  24. Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007 Jul 26. 357(4):340-8. [Medline].

  25. Pectasides D, Pectasides M, Farmakis D, Aravantinos G, Nikolaou M, Koumpou M. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. 2004 Mar. 15(3):493-7. [Medline].

  26. Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009 Feb 26. 360(9):902-11. [Medline].

  27. Haugnes HS, Aass N, Fosså SD, Dahl O, Brydøy M, Aasebø U, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27 (17):2779-86. [Medline]. [Full Text].

  28. Willemse PM, Hamdy NA, de Kam ML, Burggraaf J, Osanto S. Changes in Bone Mineral Density in Newly Diagnosed Testicular Cancer Patients After Anti-cancer treatment. J Clin Endocrinol Metab. 2014 Aug 13. jc20141722. [Medline].

  29. van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer. 2006 May. 42(7):820-6. [Medline].

  30. Albers P, Siener R, Krege S, Schmelz HU, Dieckmann KP, Heidenreich A. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008 Jun 20. 26(18):2966-72. [Medline].

  31. Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol. 2005 Jul-Aug. 19(6):683-92; discussion 692. [Medline].

  32. Aparicio J, Germa JR, Garcia del Muro X, Maroto P, Arranz JA, Saenz A. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005 Dec 1. 23(34):8717-23. [Medline].

  33. Beck SD, Foster RS, Bihrle R, Cheng L, Donohue JP. Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?. J Urol. 2005 Oct. 174(4 Pt 1):1287-90; discussion 1290. [Medline].

  34. Beck SD, Foster RS, Bihrle R, Cheng L, Ulbright TM, Donohue JP. Impact of the number of positive lymph nodes on disease-free survival in patients with pathological stage B1 nonseminomatous germ cell tumor. J Urol. 2005 Jul. 174(1):143-5. [Medline].

  35. Bokemeyer C. Bleomycin in testicular cancer: will pharmacogenomics improve treatment regimens?. J Clin Oncol. 2008 Apr 10. 26(11):1783-5. [Medline].

  36. Chaganti RS, Houldsworth J. Genetics and biology of adult human male germ cell tumors. Cancer Res. 2000 Mar 15. 60(6):1475-82. [Medline].

  37. Chung PW, Warde PR, Panzarella T, Bayley AJ, Catton CN, Milosevic MF. Appropriate radiation volume for stage IIA/B testicular seminoma. Int J Radiat Oncol Biol Phys. 2003 Jul 1. 56(3):746-8. [Medline].

  38. Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003 Mar 15. 21(6):1101-6. [Medline].

  39. Classen J, Schmidberger H, Meisner C, Winkler C, Dunst J, Souchon R. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer. 2004 Jun 14. 90(12):2305-11. [Medline].

  40. Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008 Jan 20. 26(3):421-7. [Medline].

  41. Daugaard G, Petersen PM, Rørth M. Surveillance in stage I testicular cancer. APMIS. 2003 Jan. 111(1):76-83; discussion 83-5. [Medline].

  42. De Giorgi U, Rosti G, Aieta M, Testore F, Burattini L, Fornarini G. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol. 2006 Nov. 50(5):1032-8; discussion 1038-9. [Medline].

  43. de Wit R. Optimal management of retroperitoneal metastatic nonseminomatous testicular cancer: toward a better selection between scalpel and needle. J Clin Oncol. 2007 Dec 10. 25(35):5550-2. [Medline].

  44. de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001 Mar 15. 19(6):1629-40. [Medline].

  45. Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA. 2008 Feb 13. 299(6):672-84. [Medline].

  46. Haugnes HS, Aass N, Fossa SD, et al. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. 2009 Jun 10. 27(17):2779-86. [Medline].

  47. Hinton S, Catalano PJ, Einhorn LH, Nichols CR, David Crawford E, Vogelzang N. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. 2003 Apr 15. 97(8):1869-75. [Medline].

  48. Holm M, Hoei-Hansen CE, Rajpert-De Meyts E, Skakkebaek NE. Increased risk of carcinoma in situ in patients with testicular germ cell cancer with ultrasonic microlithiasis in the contralateral testicle. J Urol. 2003 Oct. 170(4 Pt 1):1163-7. [Medline].

  49. Horvath A, Korde L, Greene MH, Libe R, Osorio P, Faucz FR, et al. Functional phosphodiesterase 11A mutations may modify the risk of familial and bilateral testicular germ cell tumors. Cancer Res. 2009 Jul 1. 69(13):5301-6. [Medline]. [Full Text].

  50. Houck W, Abonour R, Vance G, Einhorn LH. Secondary leukemias in refractory germ cell tumor patients undergoing autologous stem-cell transplantation using high-dose etoposide. J Clin Oncol. 2004 Jun 1. 22(11):2155-8. [Medline].

  51. Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol. 2005 Feb 20. 23(6):1200-8. [Medline].

  52. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004 Jan 1. 22(1):108-14. [Medline].

  53. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004 Jan 1. 22(1):108-14. [Medline].

  54. Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. 2005 Dec 20. 23(36):9290-4. [Medline].

  55. Kondagunta GV, Bacik J, Donadio A, Bajorin D, Marion S, Sheinfeld J. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005 Sep 20. 23(27):6549-55. [Medline].

  56. Melchior D, Muller SC, Albers P. Extensive surgery in metastatic testicular cancer. Aktuelle Urol. 2003 Jul. 34(4):214-22. [Medline].

  57. Motzer RJ, Rodriguez E, Reuter VE, et al. Molecular and cytogenetic studies in the diagnosis of patients with poorly differentiated carcinomas of unknown primary site. J Clin Oncol. 1995 Jan. 13(1):274-82. [Medline].

  58. R. T. Oliver, G. M. Mead, P. J. Fogarty, S. P. Stenning, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. 2008. 26:(May 20 suppl; abstr 1).

  59. Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2004 Sep 15. 22(18):3713-9. [Medline].

  60. Shamash J, Stebbing J, Powles T. Germ-cell tumors. N Engl J Med. 2007 Oct 25. 357(17):1771-2; author reply 1773-4. [Medline].

  61. Sheinfeld J, Motzer RJ. Stage I testicular cancer management and necessity for surgical expertise. J Clin Oncol. 2008 Jun 20. 26(18):2934-6. [Medline].

  62. Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009 May 1. 27(13):2122-8. [Medline].

 
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Table. Incidence of Testicular Cancer by Race
Incidence of Testicular Cancer by Race
Race/Ethnicity Annual rate per 100,000 men
All Races 5.7
White 6.7
Black 1.5
Asian/Pacific Islander 2.1
American Indian/Alaska Native 4.9
Hispanic 5.0
Table 1. Serum Tumor Markers
       
Stage LDH HCG (mIU/mL) AFP (ng/mL)
       
S1 < 1.5 times normal < 5,000 < 1,000
S2 1.5-10 times normal 5,000-50,000 1,000-10,000
S3 >10 times normal >50,000 >10,000
LDH=lactate dehydrogenase; HCG=beta human chorionic gonadotropin; AFP=alpha fetoprotein.  
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