The management of testis cancer

Testicular cancers diagnosed in adults are primarily germ cell tumours (GCT, 95%) with a smaller proportion being sex cord-stromal tumours (5%). GCTs are a histologically diverse spectrum of tumours, broadly categorized to seminoma and non-seminomatous germ cell tumour (NSGCT). Treatment is based on histological subtype and stage and involves radical inguinal orchidectomy alongside surveillance, chemotherapy, radiotherapy or retroperitoneal lymph node dissection. Serum tumour markers including β-human chorionic gonadotrophin and α-fetoprotein and lactate dehydrogenase have a unique role in staging, prognosis, treatment planning and surveillance after initial orchidectomy. In this review we outline staging and prognostic classifications used in testicular GCT and the surgical and non-surgical treatment of testicular GCT as advised by the US National Comprehensive Cancer Network (NCCN), the European Association of Urology (EAU) and the consensus recommendations from The European Society for Medical Oncology (ESMO). Additional considerations related to GCT treatment are also outlined including fertility preservation, chemotherapy and radiotherapy toxicity and late secondary malignancy.