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Diagnosis, Staging and Management of Testis Cancer

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Urologic Principles and Practice

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Testis cancer is the most common solid malignancy in young men. Over 90% are germ cell tumours (GCTs), sub-categorised into seminoma and non-seminoma.

Investigation of a testis mass is with ultrasound, CT imaging and tumour marker assay before surgery by radical inguinal orchidectomy if tumour is suspected. Disease localised to the scrotum is curable with surgery alone in most cases but high risk features in clinical stage I disease (CS1) predict failure in a proportion. Post-operative surveillance is appropriate for most CS1 cases with adjuvant treatment advocated for some with high risk characteristics.

Advanced disease (CS2 or greater) requires urgent treatment with combination chemotherapy, usually including bleomycin, etoposide and platinum (BEP). Post chemotherapy tumour masses are resected surgically when possible. Metastatic disease is sub-stratified into low, intermediate and high risk based on the extent and location of metastases and the post-orchidectomy level of specific tumour markers. This enables use of risk stratified treatment regimens tailored to individual patients according to their disease characteristics.

Cure is possible in most, with 5-year overall survival rates of 97% overall, although high risk NSGCT still has a mortality >50%. Reducing treatment related toxicity whilst improving outcomes is an ongoing priority in this disease.

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Correspondence to Noel W. Clarke .

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Clarke, N.W. (2020). Diagnosis, Staging and Management of Testis Cancer. In: Chapple, C., Steers, W., Evans, C. (eds) Urologic Principles and Practice. Springer Specialist Surgery Series. Springer, Cham.

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