Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

TLDR

Testicular cancer, though <1 % of all male tumors, is the most common solid tumor in men aged 20–34, has a rising incidence, is largely germ‑cell tumors (95 %) with seminoma and nonseminoma subtypes, and while 5‑year survival exceeds 70 %, brain metastases carry a >50 % one‑year mortality. This NCCN guideline excerpt focuses on recommendations for managing adult patients with nonseminomatous testicular germ‑cell tumors. Treatment involves radical inguinal orchiectomy followed by post‑orchiectomy management tailored to stage, histology, and risk, with options for nonseminoma including surveillance, systemic therapy, and nerve‑sparing retroperitoneal lymph node dissection.

Abstract

Testicular cancer is relatively uncommon and accounts for <1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nerve-sparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with >50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.