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Testicular cancer

Abstract

Testicular cancer is the most common malignancy among men between 14 and 44 years of age, and its incidence has risen over the past two decades in Western countries. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. Progress has been made in our understanding of the disease since the initial description of carcinoma in situ of the testis in 1972 (now referred to as germ cell neoplasia in situ), which has led to improved treatment options. The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer, although some patients become refractory to chemotherapy or have a late relapse; an improved understanding of the molecular determinants underlying tumour sensitivity and resistance may lead to the development of novel therapies for these patients. This Primer provides an overview of the biology, epidemiology, diagnosis and current treatment guidelines for testicular cancer, with a focus on germ cell tumours. We also outline areas for future research and what to expect in the next decade for testicular cancer.

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Fig. 1: Schematic representation of the types of testicular germ cell tumours.
Fig. 2: Timeline of major events in the treatment of testicular cancer.
Fig. 3: Rates of testicular cancer.

Data from ref.24.

Fig. 4: Normal embryonic development and the origin of the germ cell lineage.

Adapted from ref.9, Springer Nature Limited.

Fig. 5: The physiological process of male germ cell development.
Fig. 6: Proposed pathogenetic model for the formation of germ cell neoplasia in situ.
Fig. 7: Key somatic alterations occurring in type II testicular germ cell tumours.

Adapted from ref.115, Springer Nature Limited.

Fig. 8: Testicular germ cell tumours.
Fig. 9: Treatment of stage I nonseminomatous germ cell tumours.
Fig. 10: Algorithms for the treatment of advanced-stage germ cell tumours.

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Acknowledgements

D.M.B. is supported by an Orchid Research Grant from the UK (https://orchid-cancer.org.uk).

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Introduction (L.C.); Epidemiology (G.D.); Mechanisms/pathophysiology (L.H.J.L.); Diagnosis, screening and prevention (D.M.B.); Management (P.A.); Quality of life (T.G.); Outlook (D.R.F.); Overview of the Primer (L.C.).

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Correspondence to Liang Cheng.

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Cheng, L., Albers, P., Berney, D.M. et al. Testicular cancer. Nat Rev Dis Primers 4, 29 (2018). https://doi.org/10.1038/s41572-018-0029-0

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