Does an undescended testicle (cryptorchidism) increase the risk of testicular cancer?

Undescended Testicle Significantly Increases Risk of Testicular Cancer

Yes, cryptorchidism (undescended testicle) significantly increases the risk of testicular cancer, with men having a 3.6-7.4 times higher risk compared to the general population, and approximately 2-6% of men with a history of cryptorchidism will develop testicular cancer. 1

Risk Magnitude and Distribution

The increased risk of testicular cancer varies based on several factors:

• Overall risk increase: 3.6-7.4 times higher than general population 1
• Ipsilateral vs. contralateral risk:
  • Undescended testis (ipsilateral): 6.33 times higher risk 2
  • Normal descended testis (contralateral): 1.74 times higher risk 2
• Location of tumor development: In men with unilateral cryptorchidism who develop testicular cancer, approximately 79% of tumors occur in the previously undescended testis, while 21% occur in the contralateral normally descended testis 2

Risk Modifiers

Several factors affect the magnitude of cancer risk:

• Age at surgical correction: The risk increases with delayed treatment
  • Treatment before age 13: Relative risk of 2.23 compared to general population
  • Treatment at age 13 or older: Relative risk of 5.40 3
• Surgical correction status: Highest risk in men whose cryptorchid testis was never surgically corrected 4
• Bilateral vs. unilateral: Both conditions increase risk, but bilateral cryptorchidism may carry higher risk

Clinical Management Implications

Based on this increased risk, the European Association of Urology and American Urological Association recommend:

1. Early surgical intervention: Orchidopexy performed before puberty reduces the risk of testicular cancer, though risk remains elevated compared to men without cryptorchidism 1

2. Adult management options:

   • For adults with unilateral undescended testis and normal contralateral testis: Orchidectomy may be offered to reduce cancer risk 1, 5
   • For adults with bilateral undescended testes or impaired contralateral function: Orchidopexy with simultaneous testicular biopsy to detect intratubular germ cell neoplasia 1, 5

3. Surveillance recommendations:

   • Regular testicular self-examination after puberty 1
   • Men with cryptorchidism should be counseled about their increased cancer risk 1

Common Pitfalls and Caveats

• Persistent risk after correction: Even with early orchidopexy, the risk of testicular cancer remains elevated compared to men without cryptorchidism 1
• Contralateral risk: The normally descended testis in men with unilateral cryptorchidism still has a slightly elevated cancer risk (1.74 times higher) 2
• Hormonal treatment ineffectiveness: Hormonal treatment is not recommended for cryptorchidism in postpubertal men 1
• Fertility considerations: While this question focuses on cancer risk, it's worth noting that men with history of bilateral cryptorchidism have significantly reduced fertility (paternity rates of 35-53%) compared to those with unilateral cryptorchidism (who have near-normal fertility) 1, 5

Understanding this increased risk is essential for appropriate patient counseling, management decisions, and surveillance strategies in men with a history of cryptorchidism.