Although testicular cancer can be derived from any cell type found in the testicles, more than 95% of testicular cancers are germ cell tumors. Most of the remaining 5% are sex cord-gonadal stromal tumours derived from Leydig cells or Sertoli cells. Thus, the focus of diagnosis is on determining which germ cell tumor is present. Correct diagnosis is necessary to ensure the most effective and least harmful treatment. To some extent, this can be done via blood tests for tumor markers, but differential diagnosis requires examination of the histology of a specimen by a pathologist.
Staging
After removal, a testicular tumor is staged by a pathologist according to the TNM Classification of Malignant Tumors as published in the AJCC Cancer Staging Manual. Testicular cancer is categorized as being in one of three stages (which have subclassifications). The size of the tumor in the testis is irrelevant to staging. In broad terms, testicular cancer is staged as follows:
- Stage I: the cancer remains localized to the testis.
- Stage II: the cancer involves the testis and metastasis to retroperitoneal and/or Paraaortic lymph nodes (lymph nodes below the diaphragm).
- Stage III: the cancer involves the testis and metastasis beyond the retroperitoneal and Paraaortic lymph nodes. Stage III is further subdivided into nonbulky stage III and bulky stage III.
- Stage IV: if there is liver and/or lung secondaries
Histology
After removal, a testicular tumor is classified by a pathologist according to its histology.
Germ cell tumors of the testis, by frequency
It contained the following materials
- 40% mixed (usually teratoma plus another)
- 35% seminoma (germinoma of the testis)
- 20% embryonal carcinoma
- 5% teratoma (pure)
- <1% choriocarcinoma
- Endodermal sinus tumor
- Gonadoblastoma
Also: Intratubular germ cell neoplasms (the ''in situ'' stage of germ cell tumors)
Non-germ cell tumors of the testis
- Sex cord-gonadal stromal tumour (usually benign)
Secondary tumors of the testis
- Lymphoma
- Leukemic infiltration of the testis
- Metastatic tumors (prostate, lung, GI, renal, melanoma)
Further Reading
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"Testicular cancer"
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