Classification

1. Primary 95%
   • Germ cell (seminoma, teratoma)
   • Non-germ cell
2. Secondary 5%
   • Lymphoma
   • Metastatic (lymphoma, leukaemia, melanoma)

Risk factors

1. Testicular maldescent (1/20 have malignancy)
2. Mumps orchitis
3. Trauma
4. Maternal oestrogen exposure
5. Genetics: 12p chromosomal abnormalities

Royal Marsden Hospital Staging system

• I: Confined to testis
• II: Confined to testis but with persistently raised tumour markers
• III: Infradiaphragmatic node involvement
• IV: both sides of diaphragm
• V: Extralymphatic metastases 

Management

1. History
   • Risk factors - trauma, mumps, maledescent, maternal oestrogen
   • Genetics
2. Examination
   • Regional nodes - drain to para-aortic
3. Investigations
   • Blood tests: Tumour marker assay, aFP, LDH, HhcG
   • CXR: Pulmonary metastases
   • USS scrotum
   • Chest / abdominal CT - detection of metastases in retroperitoneum and mediastinum
4. Treatment
   • Scrotal exploration: if diagnosis is uncertain; scrotum can be explored and possible tumour biopsy
   • Orchidectomy: if there is any doubt
   • Radiotherapy (seminomas highly radiosensitive)
   • Chemotherapy for advanced stage disease