SU30.6 | Tumours of Testis — Summary & Reflection

KEY TAKEAWAYS

A painless, firm, intratesticular lump in a man aged 15–35 is a germ-cell cancer until proven otherwise (you cannot get above it; it does not transilluminate). About 95% of testicular tumours are germ-cell tumours, divided into seminoma and NSGCT (embryonal carcinoma, yolk-sac, choriocarcinoma, teratoma, mixed); the minority are sex-cord stromal tumours (Leydig/Sertoli), and lymphoma is the commonest testicular tumour over 60. Cryptorchidism is the main risk factor. Tumour markers: AFP is raised in NSGCT (yolk-sac/embryonal) and is never raised by a pure seminoma; beta-hCG may be raised in some seminomas and is high in choriocarcinoma; LDH reflects tumour bulk — all measured before and after treatment. Investigation is by scrotal ultrasound, markers and a staging CT chest/abdomen/pelvis; because the testis drains to the para-aortic nodes, a trans-scrotal biopsy/approach is absolutely forbidden (seeding and altered drainage). Treatment is a radical inguinal orchidectomy with high cord ligation (diagnostic and therapeutic), preceded by sperm banking, followed by stage- and type-directed therapy — seminoma is highly radiosensitive/chemosensitive, NSGCT is treated with platinum-based chemotherapy (BEP) ± RPLND — making testicular GCTs among the most curable solid cancers.

REFLECT

Imagine the next young man who mentions, almost in passing, that he has felt 'something' in a testicle. Would you take it seriously enough to examine carefully and recognise that a solid intratesticular lump in a man of his age is a cancer until proven otherwise — rather than reassuring him because he looks fit and well? If you suspected a tumour, are you confident you would send AFP, beta-hCG and LDH before any surgery, arrange an ultrasound and a staging CT, and — crucially — make sure that nobody put a needle or a scrotal incision anywhere near it? Would you remember to offer sperm banking before treatment, and could you honestly reassure the patient that even advanced testicular cancer is usually curable? Reflect on how a single correct decision — the inguinal, not scrotal, route — and the precise reading of three tumour markers shape the outcome of one of medicine's most curable cancers.