Recent Trends in Management of Testicular Cancer

Abstract

Testicular cancer is relatively rare cancer that accounts for about 1- 1.5% of male cancers and mainly affects younger men in the third or fourth decade of life .It can be classified into three categories :germ cell tumors (90-95%), cord stromal tumors and miscellaneous (Albers et al, 2012). The total crude incidence of testicular and paratesticular cancers was 31.5/1,000,000 person / years, 55% of which were seminomatous and 38% were non-seminomatous. Seminomatous testicular cancer was the most common entity with a total crude incidence of 17/1,000,000, followed by non-seminomatous testicular cancer (12/1,000,000) (Trama et al, 2012). Germ cell tumor (GCT) is a unique neoplasm where biochemical markers play a critical role. Serum tumor markers in patients with testicular cancer are integral in patient management, contributing to diagnosis, staging and risk assessment, evaluation of response to therapy, and detection of relapse (Ehrlich et al, 2010). Radical orchidectomy is currently considered the standard treatment for testis tumors of malignant or unknown origin. In the last 2 decades, however, due to the improvement in oncologic outcome and growing attention devoted to functional issues of cancer survivorship, the management of testis tumors has started to evolve in favour of conservative surgery, mirroring the current trend of organ preservation in the treatment of several other cancers (Giannarini et al, 2010). Conservative treatment allows maintaining fertility, avoids the risk of future hypogonadism, and as a result improves the quality of life by preserving the body image. Nonetheless, most urologists still believe that Introduction & Aim 2 when the tumor is located in one testis in the presence of a contralateral normal organ or when the tumour mass is 75% of the testicular volume and frozen section examination reports a suspicious malignant lesion, radical surgery should be preferred over sparing surgery (Stefani et al, 2012). The prognosis for testicular cancer is excellent, with surgery management a 5-year survival rate greater than 95%. Patients affected can therefore expect to be cured after treatment. Successful treatment requires good assessment of the condition and strict follow up (Brunereau et al, 2012).