Testicular Germ Cell Tumors

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Synonyms

TGCTs,

Overview

Testicular Germ Cell Tumors (TGCTs) are the most common testicular cancers, arising from sperm precursor cells (germ cells), prevalent in young men (15-35) and highly treatable. They primarily fall into Seminomas and Nonseminomas, with mixed tumors treated as nonseminomas. Risk factors include undescended testicles, family history, and certain genetic predispositions, while they are characterized by sensitivity to chemotherapy, often leading to excellent outcomes, though long-term effects and fertility preservation are key concerns. 

Symptoms

Testicular germ cell tumor symptoms often start as a painless lump or swelling in the testicle, feeling of heaviness, or an unusually shaped testicle, but can also cause lower abdominal/groin pain, back pain, or breast enlargement (gynecomastia). If the tumor spreads (metastasis), symptoms depend on location: cough/trouble breathing (chest), leg weakness (spine), or constipation/urinary issues (pelvis).

Causes

The exact cause of testicular germ cell tumors (TGCTs) isn’t fully known, but they stem from DNA changes in embryonic germ cells, often linked to genetics and developmental issues like undescended testicles (cryptorchidism), a major risk factor, plus genetic syndromes (Klinefelter’s) and birth defects in genitals/urinary tract, with some theories pointing to prenatal hormonal/environmental factors, though specific links need more research. 

Prevention

You can’t fully prevent testicular germ cell tumors (TGCTs), as many risk factors (like family history, undescended testicles) are unchangeable, but early detection through monthly self-exams and prompt medical care for any lumps is crucial for successful treatment. Managing known risks like undescended testicles (orchiopexy in childhood) and using protective gear during sports can help, as can a healthy lifestyle, though direct prevention isn’t guaranteed. 

Diagnosis

Diagnosing Testicular Germ Cell Tumors (TGCTs) involves a multi-step process starting with a doctor’s physical exam for lumps, followed by imaging like an ultrasound to see the testicle, blood tests for tumor markers (AFP, HCG), and often a CT scan to check for spread. The definitive diagnosis comes from a radical inguinal orchiectomy (testicle removal) for pathological (histological) examination, which confirms cancer type and guides treatment. 

Prognosis

Testicular germ cell tumors (TGCTs) have an excellent prognosis, often considered one of the most curable cancers, with overall 5-year survival rates over 90% and localized disease exceeding 99%. Prognosis depends on risk factors like stage, tumor markers (AFP, hCG, LDH), and spread (metastasis), but even advanced cases have good outcomes with modern treatment (surgery, chemotherapy), though long-term monitoring for treatment side effects (cardiovascular, fertility) is crucial.

Treatment

Testicular Germ Cell Tumor (TGCT) treatment primarily involves surgery (radical orchidectomy) to remove the testicle, followed by surveillance or adjuvant therapy like cisplatin-based chemotherapy (BEP/EP) or radiation for higher-risk cases, depending on stage and type. For metastatic disease, chemotherapy is crucial, with surgery sometimes needed for remaining masses. TGCTs have excellent cure rates, but resistance to platinum chemotherapy can occur, requiring advanced options like stem cell transplants.