Feature Article

Testicular cancer. Key issues in diagnosis, treatment and follow up

Feature Article

Testicular cancer. Key issues in diagnosis, treatment and follow up

BRAYDEN MARCH, Nariman Ahmadi

Figures

© izusek/istockphoto.com models used for illustrative purposes only
© izusek/istockphoto.com models used for illustrative purposes only

Abstract

Testicular cancer is the most commonly diagnosed malignancy in men aged under 40 years. Eliciting red flags for metastatic disease and discussing fertility are key issues in the early diagnostic process. Monitoring for long-term sequelae of treatment and potential relapse is important in the management of survivors of testicular cancer.

Key Points

  • Testicular cancer is the most commonly diagnosed malignancy in men aged under 40 years.
  • Men presenting with a testicular lump and a solid intratesticular lesion on ultrasound need an urgent urology referral as most types of testicular cancer are rapidly progressing.
  • Surveillance of lower stage disease is the recommended strategy to minimise morbidity of adjuvant chemotherapy, radiotherapy or surgery but requires clinicians to be vigilant for relapse.
  • Chemotherapy, radiotherapy and surgery with retroperitoneal lymph node dissection are treatment options after orchidectomy for higher stage testicular cancer or lower-stage cancers with possible occult metastasis.
  • It can take on average two years for fertility to recover after adjuvant treatment. Therefore, a family planning discussion about semen cryobanking before treatment is paramount.
  • Testicular cancer survivors should be monitored for relapse, cardiovascular disease, secondary malignancy and hypogonadism.