Write a short note on Testicular Tumours.

The Concept

Testicular tumours are important because, although uncommon, they are the commonest solid malignancy in young men (aged ~20–40) and are highly curable if managed correctly. The great majority are germ cell tumours, divided into two groups that behave and are treated differently: seminoma and non-seminomatous germ cell tumours (NSGCT).

Types, Risk & Presentation

Seminoma is the commonest single type, tends to occur slightly later, and is radiosensitive. NSGCTs include teratoma, yolk-sac tumour and choriocarcinoma. The major risk factor is a history of cryptorchidism (undescended testis). The typical presentation is a painless, firm, hard testicular lump or swelling that does not transilluminate.

Tumour Markers, Investigation & Treatment

Tumour markers are central: alpha-fetoprotein (AFP) is raised in NSGCT (yolk-sac elements), beta-hCG in choriocarcinoma and some seminomas, and LDH reflects tumour bulk. Investigation is by scrotal ultrasound and markers, with CT for staging. A cardinal rule is that the testis is never biopsied through the scrotum (this risks tumour spread and alters lymphatic drainage); instead a radical inguinal orchidectomy is performed, which is both diagnostic and therapeutic. Further chemotherapy or radiotherapy is given according to type and stage, with an excellent overall prognosis.

Staging & Prognosis

After orchidectomy, staging (with CT and post-orchidectomy tumour markers) and the tumour type guide further treatment: seminomas are exquisitely radiosensitive and chemosensitive, while NSGCTs are treated primarily with platinum-based chemotherapy for metastatic disease. Testicular germ cell tumours are among the most curable of all solid cancers — even metastatic disease has high cure rates — which is why prompt, correct management (never a scrotal biopsy) matters so much.

The Bottom Line

Testicular tumours are the commonest cancer of young men, usually germ-cell (seminoma vs NSGCT), diagnosed by ultrasound and markers and treated by radical inguinal orchidectomy (never a scrotal biopsy) plus chemo/radiotherapy, with excellent cure rates.

A Note on Undescended Testis

The link with cryptorchidism (undescended testis) is worth expanding: an undescended testis carries a significantly increased risk of malignancy (and the risk applies to both testes), which is one reason orchidopexy is performed in childhood. Even after correction the risk is not fully abolished, so men with a history of undescended testis are advised to perform testicular self-examination. This preventive angle complements the treatment of established tumours.

AFP is never raised in pure seminoma.

• Testicular tumours: commonest solid cancer in young men (20–40); mostly germ cell — seminoma (radiosensitive) vs NSGCT (teratoma, yolk sac, choriocarcinoma).
• Risk factor: cryptorchidism (undescended testis); presents as a painless, hard testicular lump (doesn't transilluminate).
• Markers: AFP (NSGCT/yolk sac), beta-hCG (choriocarcinoma, some seminoma), LDH; ultrasound + CT staging.
• Never biopsy through the scrotum (spread) → radical inguinal orchidectomy (diagnostic + therapeutic) + chemo/radiotherapy; excellent prognosis.