This document summarizes epidemiology, staging, and management of testicular cancer. It covers the following key points: - Testicular cancer most commonly affects white males aged 15-35. Risk factors include cryptorchidism and family history. - Staging involves physical exam, tumor markers, CT scans, and classification based on tumor size and spread. Seminomas are more common in stage I and radiosensitive. Non-seminomas have higher stages and marker levels. - Treatment depends on stage and risk factors but may include surveillance, radiation, chemotherapy, and surgery. Chemotherapy regimens like BEP are effective while carrying risks like lung toxicity from bleomycin.

1. Epidemiology, Staging and Management G. Pentheroudakis University of Ioannina

2. Epidemiology Most common tumour in males 15-35 age group. White (ratio of white to black is approximately 5:1) Incidence 3/100,000 of general population. Lifetime probability: 0.2% Risk factors Cryptorchidism ( Relative risk 8-40) Prior testicular cancer ( Relative risk 25) Genetic (Klinefelter syndrome, Down syndrome, testicular feminization) Carcinoma in situ (intratubular germ cell neoplasia): 50-100% progression to invasive cancer in 10 years. Family history ( Relative risk 10 in brothers, 4 in sons)

4. CIS

5. PLAP immunothistochemistry HE staining

9. WHO British Tumour Panel Seminoma Classical Anaplastic Seminoma Εmbryonal Carcinoma ΜΤ U Choriocarcinoma ΜΤΤ Τeratoma Mature Immature With malignant transformation ΜΤ D Yolk sac tumour Yolk sac tumour Μixed tumours ΜΤΙ

23. Good risk Any HCG AFP 1000 ng/mL Any LDH HCG 5000 mIU/mL Nonpulmonary visceral metastases absent LDH 1.5 upper limit of normal Any primary site Nonpulmonary visceral metastases absent Gonadal or retroperitoneal primary tumor Intermediate risk Nonpulmonary visceral metastases present AFP 1000-10,000 ng/mL Any HCG HCG 5000-50,000 mIU/mL Any LDH LDH 1.5-10.0 upper limit of normal Any primary site Nonpulmonary visceral metastases absent Gonadal or retroperitoneal primary site Poor risk Mediastinal primary site Nonpulmonary visceral metastases present ( eg , bone, liver, brain) AFP 10,000 ng/mL HCG 50,000 mIU/mL SEMINOMAS LDH 10 upper limit of normal NSGCT

24. NSCGT Seminomas Good prognosis 5y OS 92% 5y OS 86% Intermediate prognosis 5y OS 80% 5y OS 73% Poor prognosis 5y OS 48%

27. Fewer testicular new primary tumors with carboplatin

32. PE 500 B 90 x3 PE 500 B 90 x4 No. of patients 88 96 NED after Rx 86 (98%) 93 (97%) Relapse 5 (6%) 5 (5%) Continously NED 81 (92%) 88 (92%)

46. Risk factors are: Presence of CIS and radiotherapy