Singla Nirmish, Bagrodia Aditya, Baraban Ezra, Fankhauser Christian D, Ged Yasser M A
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA. 2025 Mar 4;333(9):793-803. doi: 10.1001/jama.2024.27122.
Testicular cancer is the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year. Between 90% and 95% of testicular cancers are germ cell tumors (GCTs).
The mean age at diagnosis for testicular cancer is 33 years. GCTs are categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation. Risk factors include cryptorchidism, family history of testicular cancer, gonadal dysgenesis, infertility, cannabis use, and genetic conditions such as Klinefelter syndrome. The most common presenting symptom of testicular cancer is a painless testicular mass. History, physical examination, scrotal ultrasound, laboratory assessment of GCT-associated serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase), and prompt referral to a urologist are indicated when testicular cancer is suspected. Early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important to optimize outcomes. At diagnosis, GCT is stage I (localized to the testicle) in 70% to 75% of patients, stage II (metastatic only to the retroperitoneal lymph nodes) in 20%, and stage III (widely metastatic) in 10%. Treatment of GCTs is guided by histology, clinical staging, and risk classification, with 5-year survival rates of 99%, 92%, and 85% for those diagnosed at stages I, II, and III, respectively. Optimal treatment often involves a multidisciplinary team at high-volume, experienced medical centers and may include surveillance (serum tumor markers [α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase] and imaging of the chest, abdomen, and pelvis), surgery (retroperitoneal lymph node dissection), chemotherapy, and/or radiation. Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy such as cardiovascular disease, secondary malignancies, and potential psychosocial effects such as anxiety, depression, and social isolation.
Testicular cancer is the most common solid malignancy in young men in the US, and 90% to 95% are GCTs. Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively. Prompt diagnosis and treatment are important to optimize outcomes, and treatment decisions should balance oncologic control with survivorship concerns to minimize long-term adverse effects of treatment.
睾丸癌是美国15至40岁男性中最常见的实体恶性肿瘤，每年约有10000例新病例被诊断出来。90%至95%的睾丸癌是生殖细胞肿瘤（GCT）。
睾丸癌的诊断平均年龄为33岁。根据其胚胎起源和分化途径，GCT分为精原细胞瘤和非精原细胞瘤性GCT（NSGCT）。风险因素包括隐睾、睾丸癌家族史、性腺发育不全、不育、使用大麻以及克氏综合征等遗传疾病。睾丸癌最常见的症状是无痛性睾丸肿块。当怀疑患有睾丸癌时，应进行病史采集、体格检查、阴囊超声检查、对与GCT相关的血清肿瘤标志物（甲胎蛋白、β-人绒毛膜促性腺激素和乳酸脱氢酶）进行实验室评估，并及时转诊给泌尿科医生。早期诊断和治疗，首先进行根治性腹股沟睾丸切除术，对于优化治疗效果很重要。在诊断时，70%至75%的患者GCT处于I期（局限于睾丸），20%处于II期（仅转移至腹膜后淋巴结），10%处于III期（广泛转移）。GCT的治疗以组织学、临床分期和风险分类为指导，I期、II期和III期诊断患者的5年生存率分别为99%、92%和85%。最佳治疗通常需要在大型、经验丰富的医疗中心由多学科团队进行，可能包括监测（血清肿瘤标志物[甲胎蛋白、β-人绒毛膜促性腺激素和乳酸脱氢酶]以及胸部、腹部和骨盆的影像学检查）、手术（腹膜后淋巴结清扫术）、化疗和/或放疗。治疗决策应考虑长期生存相关问题，包括身体形象、生育能力、性腺功能减退、心理健康、经济成本、坚持随访以及治疗的晚期不良反应，如心血管疾病、继发性恶性肿瘤以及潜在的心理社会影响，如焦虑、抑郁和社会隔离。
睾丸癌是美国年轻男性中最常见的实体恶性肿瘤，90%至95%为GCT。睾丸GCT患者I期、II期和III期的5年生存率分别为99%、92%和85%。及时诊断和治疗对于优化治疗效果很重要，治疗决策应在肿瘤控制和生存相关问题之间取得平衡，以尽量减少治疗的长期不良反应。
