Management of testicular tumours

Testis cancer is rare, but it is the commonest cause of malignancy in young men.Painless scrotal masses must be investigated with ultrasound imaging and tumour marker assay before being treated urgently with radical inguinal orchidectomy. Disease localized to the scrotum is curable with surgery alone in most cases, but high-risk features in clinical stage 1 disease predict failure in a significant proportion. Such cases need close surveillance or adjuvant intervention therapy following primary surgery. More advanced disease (clinical stage 2 or greater) requires treatment with combination platinum-based chemotherapy, usually with the cytotoxic agents, bleomycin, etoposide and cisplatinum (BEP). Post-chemotherapy tumour masses are resected surgically when this is possible. The disease is substratified into low-, intermediate- and high-risk categories based on the extent and location of metastases on cross-sectional imaging and on the level of specific tumour markers according to the European Germ Cell Cancer Consensus Group criteria. This facilitates tailoring of treatment regimens according to risk. Treatment outcome is excellent overall and this cancer is a modern model for the curable neoplasm. Notwithstanding this, therapy carries acute and long-term risks of toxic side effects and in addition, the survival in patients presenting with metastases and high-risk features only approximates to 50% at 5 years. Further developments are needed in this area of high-risk disease.