Testicular Cancer - Know Its Risks!

Here are a few things you should know about Testicular Cancer (TC): 

1. Age: The commonest affected age group is 20-45 years with germ cell tumours. Half of all cases occur in men less than 35 years. Non-seminomatous germ cell tumours (NSGCT) are more common at ages 20-35, while seminoma is more common at age 35-45 years. Rarely, infants and boys below 10 years develop yolk sac tumours and 50% men above 60 years with TC have lymphoma.
2. Race: White Caucasian people living in Europe and the US have the highest risk. Whites are three times more likely to develop TC than blacks in the US. With the exception of the New Zealand Maoris, TC is rare in non-Caucasian races.
3. Previous TC: Confers a 12-fold increased risk of metachronous TC. Bilateral TC occurs in 1-2% of cases.
4. Cryptorchidism: 5-10% of TC patients have a history of cryptorchidism. Ultrastructural changes are present in these testes by age 3 years, although earlier orchidopexy does not completely eliminate the risk of developing TC. According to a large Swedish study, cryptorchidism is associated with a two-fold increased risk of TC in men who underwent orchiopexy less than 13 year, but risk is increased 5-fold in men who underwent orchiopexy aged above13 years. A meta-analysis showed risk of contralateral TC almost doubles while ipsilateral TC risk is increased 6-fold in men with unilateral cryptorchidism.
5. Intratubular germ cell neoplasia (testicular intraepithelial neoplasia, TIN): Synonymous with carcinoma in situ, although the disease arises from malignant change in spermatogonia; 50% of cases develop invasive germ cell TC within 5 years. The population incidence is 0.8%. Risk factors include cryptorchidism, extragonadal germ cell tumour, atrophic contralateral testis, 45XO karyotype, Klinefelter's syndrome, previous or contralateral TC (5%), and infertility.
6. Human immunodeficiency virus (HIV): Patients develop seminoma 35% more frequently than expected. Genetic factors: appear to play a role, given that first-degree relatives are at higher risk by 4-9-fold, but a defined familial inheritance pattern is not apparent.
7. Maternal oestrogen exposure: At higher than usual levels during pregnancy appears to increase risk of cryptorchidism, urethral anomalies, and TC in male offspring.

Trauma and viral-induced atrophy have not been convincingly implicated as risk factors for TC.