Carl R. Darnall Army Medical Center, Fort Hood, TX, USA.
Fort Polk, LA, USA.
Am Fam Physician. 2018 Feb 15;97(4):261-268.
Testicular cancer is the most common solid tumor among males 15 to 34 years of age, with an estimated 8,850 new cases and 410 deaths during 2017 in the United States. With effective treatment, the overall five-year survival rate is 97%. Risk factors for testicular cancer include undescended testis (cryptorchidism), personal or family history of testicular cancer, age, ethnicity, and infertility. The U.S. Preventive Services Task Force recommends against routine screening in asymptomatic men. Men with symptoms should receive a complete history and physical examination. Scrotal ultrasonography is the preferred initial imaging study. If a solid intratesticular mass is discovered, orchiectomy is both diagnostic and therapeutic. Staging through chest radiography, chemistry panel, liver function tests, and tumor markers guides treatment. Active surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy are treatment options following orchiectomy. For patients desiring future fertility, sperm banking should be discussed early in the course of treatment. Family physicians often play a role in the care of cancer survivors and should be familiar with monitoring for recurrence and future complications, including secondary malignant neoplasms, cardiovascular risk, and infertility and subfertility.
睾丸癌是 15 至 34 岁男性中最常见的实体肿瘤，据估计 2017 年美国有 8850 例新发病例和 410 例死亡病例。通过有效治疗，整体五年生存率为 97%。睾丸癌的风险因素包括隐睾（睾丸未降）、个人或家族的睾丸癌病史、年龄、种族和不孕。美国预防服务工作组建议对无症状男性不进行常规筛查。有症状的男性应接受完整的病史和体格检查。阴囊超声是首选的初始影像学研究。如果发现实质性睾丸内肿块，睾丸切除术既是诊断方法也是治疗方法。通过胸部 X 线摄影、化学小组、肝功能检查和肿瘤标志物进行分期，指导治疗。睾丸切除术后，可选择主动监测、化疗、腹膜后淋巴结清扫和放射治疗。对于希望未来生育的患者，应在治疗过程早期讨论精子库存储。家庭医生通常在癌症幸存者的护理中发挥作用，应熟悉监测复发和未来并发症，包括继发性恶性肿瘤、心血管风险以及不孕和不育。
