From the Guidelines
No, testicular germ cell tumors are usually malignant, not benign. These tumors account for about 95% of all testicular cancers and are generally classified into two main types: seminomas and non-seminomas 1. While they are malignant, testicular germ cell tumors have one of the highest cure rates among all cancers, especially when detected early. According to the study published in the Journal of the American College of Radiology in 2022, more than 95% of testicular tumors are of germ cell origin and are malignant 1.
The management of testicular germ cell tumors typically involves surgical removal of the affected testicle (radical orchiectomy), often followed by radiation therapy, chemotherapy, or surveillance depending on the tumor type and stage 1. The high cure rate is due to the tumors' exceptional sensitivity to radiation and platinum-based chemotherapy regimens. Risk factors include cryptorchidism (undescended testicle), family history, and certain genetic conditions. Regular testicular self-examination is recommended for early detection, as these tumors often present as a painless lump or swelling in the testicle.
Key points to consider in the management of testicular germ cell tumors include:
- The importance of early detection and prompt medical attention for optimal outcomes
- The use of imaging surveillance to detect relapse for 5 years after orchiectomy, as recommended by the 2021 National Comprehensive Cancer Network (NCCN) guidelines 1
- The consideration of adjuvant therapy with one or two cycles of single-agent carboplatin or radiotherapy to decrease the risk of relapse in certain high-risk patients 1
- The excellent prognosis of testicular cancer, with 5-year survival rates of approximately 95% 1
From the Research
Testicular Germ Cell Tumors
- Testicular germ cell tumors (GCTs) are the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year 2.
- Between 90% and 95% of testicular cancers are GCTs, which can be categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation 2.
Benign vs. Malignant
- While the majority of testicular GCTs are malignant, some types, such as teratomas in children and dermoid cysts in adults, are benign 3.
- Spermatocytic seminoma, a tumor of elderly men, typically has an indolent clinical behavior, but rarely it undergoes sarcomatous transformation associated with an aggressive behavior 3.
- Teratomas in adults, however, have a malignant behavior 3.
Incidence and Survival Rates
- 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% 2.
- Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively 2.
- With appropriate therapy, the majority of testicular GCTs are curable 3.