Management of testicular tumours

Malignant tumours of the testis are the commonest form of cancer in young males and the worldwide incidence is rising. Primary clinical diagnosis is based on examination and sonographic findings, supplemented by serum tumour markers. A small but significant number of men present with orchitis. Initial treatment is radial inguinal orchidectomy, followed by staging and stratification of risk based on histological features, particularly vascular and lymphatic invasion. For non-semenomas, treatment for low-risk stage 1 disease varies in Europe and the US, with surveillance strategies more common in the former and primary retroperitoneal lymph node dissection more common in the latter. High-risk stage 1 disease is best managed by adjuvant chemotherapy. For stage 1 seminoma, post-surgical treatment usually comprises low-dose para-aortic radiotherapy or surveillance. Stage 2+ non-seminoma and seminoma is treated by platinum-based combination chemotherapy (usually bleomycin and etoposide) followed by resection of residual masses in specialist centres. Relapsing disease is usually managed by salvage chemotherapy alone or, where possible, in combination with salvage surgery. Early-stage disease is a highly curable condition, with long-term survival of 98%. Advanced high-risk disease has a significant long-term mortality.