Orchiectomy is the surgical removal of one or both testicles, or testes, in the human male.

It is also called an orchidectomy, particularly in British publications. The removal of both testicles is known as a bilateral orchiectomy, or castration, because the person is no longer able to reproduce. Emasculation is another word that is sometimes used for castration of a male. Castration in women is the surgical removal of both ovaries (bilateral oophorectomy ).

In an orchiectomy, the scrotum is cut open (A). Testicle covering is cut to expose the testis and spermatic cord (B). The cord is tied and cut, removing the testis (C), and the wound is repaired (D). ( Illustration by GGS Inc. Purpose An orchiectomy is done to treat cancer or, for other reasons, to lower the level of testosterone, the primary male sex hormone, in the body. Surgical removal of a testicle is the usual treatment if a tumor is found within the gland itself, but an orchiectomy may also be performed to treat prostate cancer or cancer of the male breast, as testosterone causes these cancers to grow and metastasize (spread to other parts of the body). An orchiectomy is sometimes done to prevent cancer when an undescended testicle is found in a patient who is beyond the age of puberty. A bilateral orchiectomy is commonly performed as one stage in male-to-female (MTF) gender reassignment surgery. It is done both to lower the levels of male hormones in the patient's body and to prepare the genital area for later operations to construct a vagina and external female genitalia. Some European countries and four states in the United States (California, Florida, Montana, and Texas) allow convicted sex offenders to request surgical castration to help control their sexual urges. This option is considered controversial in some parts of the legal system. A small number of men with very strong sex drives request an orchiectomy for religious reasons; it should be noted, however, that official Roman Catholic teaching is opposed to the performance of castration for spiritual purity. Demographics Cancer

Cancers in men vary widely in terms of both the numbers of men affected and the age groups most likely to be involved. Prostate cancer is the single most common malignancy affecting American men over the age of 50; about 220,000 cases are reported each year. According to the Centers for Disease Control and Prevention (CDC), 31,000 men in the United States die every year from prostate cancer. AfricanAmerican men are almost 70% more likely to develop prostate cancer than either Caucasian or Asian-American men; the reasons for this difference are not yet known. Other factors that increase a man's risk of developing prostate cancer include a diet high in red meat, fat, and dairy products, and a family history of the disease. Men whose father or brother(s) had prostate cancer are twice as likely as other men to develop the disease themselves. Today, however, there are still no genetic tests available for prostate cancer. Testicular cancer, on the other hand, frequently occurs in younger men; in fact, it is the most common cancer diagnosed in males between the ages of 15 and 34. The rate of new cases in the United States each year is about 3.7 per 100,000 people. The incidence of testicular cancer has been rising in the developed countries at a rate of about 2% per year since 1970. It is not yet known whether this increase is a simple reflection of improved diagnostic techniques or whether there are other causes. There is some variation among racial and ethnic groups, with men of Scandinavian background having higher than average rates of testicular cancer, and African-American men having a lower than average incidence. Testicular cancer occurs most often in males in one of three age groups: boys 10 years old or younger; adult males between the ages of 20 and 40; and men over 60. Other risk factors for testicular cancer include: y Cryptorchidism, which is a condition in which a boy's testicles do not move down from the abdomen into the scrotum at the usual point in fetal development. It is also called undescended testicle(s). Ordinarily, the testicles descend before the baby is born; however, if the baby is born prematurely, the scrotal sac may be empty at the time of delivery. About 34% of full-term male infants are born with undescended testicles. Men with a history of childhood cryptorchidism are three to 14 times more likely to develop testicular cancer. y Family history of testicular cancer. y A mother who took diethylstilbestrol (DES) during pregnancy. DES is a synthetic hormone that was prescribed for many women between 1938 and 1971 to prevent miscarriage. It has since been found to increase the risk of certain types of cancer in the offspring of these women. y Occupational and environmental factors. Separate groups of researchers in Germany and New Zealand reported in 2003 that firefighters have an elevated risk of testicular cancer compared to control subjects. The specific environmental trigger is not yet known. Gender reassignment Statistics for orchiectomies in connection with gender reassignment surgery are difficult to establish because most patients who have had this type of surgery prefer to keep it confidential. Persons undergoing the hormonal treatments and periods of real-life experience as members of the other sex that are required prior to genital surgery frequently report social rejection, job discrimination, and other negative consequences

of their decision. Because of widespread social disapproval of surgical gender reassignment, researchers do not know the true prevalence of gender identity disorders in the general population. Early estimates were 1:37,000 males and 1:107,000 females. A recent study in the Netherlands, however, maintains that a more accurate estimation is 1:11,900 males and 1:30,400 females. In any case, the number of surgical procedures is lower than the number of patients diagnosed with gender identity disorders. Description There are three basic types of orchiectomy: simple, subcapsular, and inguinal (or radical). The first two types are usually done under local or epidural anesthesia, and take about 30 minutes to perform. An inguinal orchiectomy is sometimes done under general anesthesia, and takes between 30 minutes and an hour to complete. Simple orchiectomy A simple orchiectomy is performed as part of gender reassignment surgery or as palliative treatment for advanced cancer of the prostate. The patient lies flat on an operating table with the penis taped against the abdomen. After the anesthetic has been given, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue. The surgeon removes the testicles and parts of the spermatic cord through the incision. The incision is closed with two layers of sutures and covered with a surgical dressing. If the patient desires, a prosthetic testicle can be inserted before the incision is closed to give the appearance of a normal scrotum from the outside. Subcapsular orchiectomy A subcapsular orchiectomy is also performed for treatment of prostate cancer. The operation is similar to a simple orchiectomy, with the exception that the glandular tissue is removed from the lining of each testicle rather than the entire gland being removed. This type of orchiectomy is done primarily to keep the appearance of a normal scrotum. Inguinal orchiectomy An inguinal orchiectomy, which is sometimes called a radical orchiectomy, is done when testicular cancer is suspected. It may be either unilateral, involving only one testicle, or bilateral. This procedure is called an inguinal orchiectomy because the surgeon makes the incision, which is about 3 in (7.6 cm) long, in the patient's groin area rather than directly into the scrotum. It is called a radical orchiectomy because the surgeon removes the entire spermatic cord as well as the testicle itself. The reason for this complete removal is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys. A long non-absorbable suture is left in the stump of the spermatic cord in case later surgery is necessary. After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. Diagnosis/Preparation Diagnosis

CANCER. The doctor may suspect that a patient has prostate cancer from feeling a mass in the prostate in the course of a rectal examination, from the results of a transrectal ultrasound (TRUS), or from elevated levels of prostate-specific antigen (PSA) in the patient's blood. PSA is a tumor marker, or chemical, in the blood that can be used to detect cancer and monitor the results of therapy. A definite diagnosis of prostate cancer, however, requires a tissue biopsy. The tissue sample can usually be obtained with the needle technique. Testicular cancer is suspected when the doctor feels a mass in the patient's scrotum, which may or may not be painful. In order to perform a biopsy for definitive diagnosis, however, the doctor must remove the affected testicle by radical orchiectomy. GENDER REASSIGNMENT. Patients requesting gender reassignment surgery must undergo a lengthy process of physical and psychological evaluation before receiving approval for surgery. The Harry Benjamin International Gender Dysphoria Association (HBIGDA), which is presently the largest worldwide professional association dealing with the treatment of gender identity disorders, has published standards of care that are followed by most surgeons who perform genital surgery for gender reassignment. HBIGDA stipulates that a patient must meet the diagnostic criteria for gender identity disorders as defined by either the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) or the International Classification of Diseases10 (ICD-10). Preparation All patients preparing for an orchiectomy will have standard blood and urine tests before the procedure. They are asked to discontinue aspirin-based medications for a week before surgery and all non-steroidal anti-inflammatory drugs (NSAIDs) two days before the procedure. Patients should not eat or drink anything for the eight hours before the scheduled time of surgery. Most surgeons ask patients to shower or bathe on the morning of surgery using a special antibacterial soap. They should take extra time to lather, scrub, and rinse their genitals and groin area. Patients who are anxious or nervous before the procedure are usually given a sedative to help them relax. CANCER. Patients who are having an orchiectomy as treatment for testicular cancer should consider banking sperm if they plan to have children following surgery. Although it is possible to father a child if only one testicle is removed, some surgeons recommend banking sperm as a precaution in case the other testicle should develop a tumor at a later date. GENDER REASSIGNMENT. Most males who have requested an orchiectomy as part of male-to-female gender reassignment have been taking hormones for a period of several months to several years prior to surgery, and have had some real-life experience dressing and functioning as women. The surgery is not performed as an immediate response to the patient's request. Because the standards of care for gender reassignment require a psychiatric diagnosis as well as a physical examination , the surgeon who is performing the orchiectomy should receive two letters of evaluation and recommendation by mental health professionals, preferably one from a psychiatrist and one from a clinical psychologist.

Aftercare Patients who are having an orchiectomy in an ambulatory surgery center or other outpatient facility must have a friend or family member to drive them home after the procedure. Most patients can go to work the following day, although some may need an additional day of rest at home. Even though it is normal for patients to feel nauseated after the anesthetic wears off, they should start eating regularly when they get home. Some pain and swelling is also normal; the doctor will usually prescribe a pain-killing medication to be taken for a few days. Other recommendations for aftercare include: y Drinking extra fluids for the next several days, except for caffeinated and alcoholic beverages. y Avoiding sexual activity, heavy lifting, and vigorous exercise until the follow-up appointment with the doctor. y Taking a shower rather than a tub bath for a week following surgery to minimize the risk of absorbable stitches dissolving prematurely. y Applying an ice pack to the groin area for the first 2448 hours. y Wearing a jock strap or snug briefs to support the scrotum for two weeks after surgery. Some patients may require psychological counseling following an orchiectomy as part of their long-term aftercare. Many men have very strong feelings about any procedure involving their genitals, and may feel depressed or anxious about their bodies or their relationships after genital surgery. In addition to individual psychotherapy, support groups are often helpful. There are active networks of prostate cancer support groups in Canada and the United States as well as support groups for men's issues in general. Long-term aftercare for patients with testicular cancer includes frequent checkups in addition to radiation treatment or chemotherapy. Patients with prostate cancer may be given various hormonal therapies or radiation treatment. Risks Some of the risks for an orchiectomy done under general anesthesia are the same as for other procedures. They include deep venous thrombosis, heart or breathing problems, bleeding, infection, or reaction to the anesthesia. If the patient is having epidural anesthesia, the risks include bleeding into the spinal canal, nerve damage, or a spinal headache. Specific risks associated with an orchiectomy include: y loss of sexual desire (This side effect can be treated with hormone injections or gel preparations.) y impotence y hot flashes similar to those in menopausal women, controllable by medication y weight gain of 1015 lb (4.56.8 kg) y mood swings or depression y enlargement and tenderness in the breasts y fatigue y loss of sensation in the groin or the genitals y osteoporosis (Men who are taking hormone treatments for prostate cancer are at greater risk of osteoporosis.)

An additional risk specific to cancer patients is recurrence of the cancer. Normal results Cancer Normal results depend on the location and stage of the patient's cancer at the time of surgery. Most prostate cancer patients, however, report rapid relief from cancer symptoms after an orchiectomy. Patients with testicular cancer have a 95% survival rate five years after surgery if the cancer had not spread beyond the testicle. Metastatic testicular cancer, however, has a poorer prognosis. Gender reassignment Normal results following orchiectomy as part of a sex change from male to female are a drop in testosterone levels with corresponding decrease in sex drive and gradual reduction of such masculine characteristics as beard growth. The patient may choose to have further operations at a later date. Morbidity and mortality rates Orchiectomy by itself has a very low rate of morbidity and mortality. Patients who are having an orchiectomy as part of cancer therapy have a higher risk of dying from the cancer than from testicular surgery. The morbidity and mortality rates for persons having an orchiectomy as part of gender reassignment surgery are about the same as those for any procedure involving general or epidural anesthesia. Alternatives Cancer There is no effective alternative to radical orchiectomy in the treatment of testicular cancer; radiation and chemotherapy are considered follow-up treatments rather than alternatives. There are, however, several alternatives to orchiectomy in the treatment of prostate cancer: y watchful waiting y hormonal therapy (The drugs that are usually given for prostate cancer are either medications that oppose the action of male sex hormones [anti-androgens, usually flutamide or nilutamide] or medications that prevent the production of testosterone [goserelin or leuprolide acetate].) y radiation treatment y chemotherapy Gender reassignment The primary alternative to an orchiectomy for gender reassignment is hormonal therapy. Most patients seeking MTF gender reassignment begin taking female hormones (estrogens) for three to five months minimum before requesting genital surgery. Some persons postpone surgery for a longer period of time, often for financial reasons; others choose to continue on estrogen therapy indefinitely without surgery.

Testicular Cancer Signs and Symptoms Medical Author: Melissa Conrad Medical Editor: William C. Shiel Jr., MD, FACP, FACR Stoppler, MD

Cancer of the testicles (testicular cancer) is an uncommon condition that accounts for only about 1% of all cancers in men. Each year, 7,000 to 8,000 new cases of testicular cancer will occur in the U.S., leading to approximately 400 deaths. Doctors do not know the exact cause of testicular cancer, but a number of risk factors for development of this disease have been identified. Young men between the ages of 15 and 39 are most often affected. White men are affected more than men of other races, although the disease can occur in men of any age and race, including children. Men who have an undescended testicle (termed cryptorchidism), even if surgery has been performed to remedy the condition, have an increased risk for the development of testicular cancer. Other risk factors include the genetic condition known as Klinefelter's syndrome, abnormal development of the testicles, and having relatives with testicular cancer. Testicular cancer is highly curable when detected early, and 95% of patients with testicular cancer are alive after a five-year period. However, about half of men with testicular cancer do not seek treatment until the cancer has spread beyond the testicles to other locations in the body (as in the case of seven-time Tour de France winner Lance Armstrong). Most testicular cancers are found by men themselves. Doctors recommend that men perform an examination of their testicles once a month (referred to as TSE or testicular self-examination) to facilitate detection of testicular cancer in its early, treatable stage. The TSE involves gentle examination of the testicles, one at a time, holding each testicle between the thumb (on top) and middle and index fingers below. Look for any small, hard lumps within the testicles or changes in the feel of the testicles. Other symptoms and signs of testicular cancer include:
y y y y y

pain or swelling in the testicles, lumps or nodules in the testicles, whether painful or not, enlargement of the testicles or change in the way a testicle feels, pain in the lower abdomen, back, or groin areas, and swelling of the scrotum or collection of fluid within the scrotum.

Many men with testicular cancer will not feel ill and may report no symptoms. It's also important to remember that other, benign conditions can cause the symptoms listed above. However, since early stage testicular cancer is curable, men should see a doctor if they have any of the warning signs or symptoms of testicular cancer. He or she can perform tests that determine whether the symptoms are due to cancer or another condition.

TESTES/TESTICULAR CANCER Overview Testes cancer, or testicular cancer, is a common disease originating in males, especially between the ages of 15-35. Most testicular cancers occur in men under the age of 40. The disease develops in the testicles, which are the male reproductive organs. More than 90% of all cancers come from germ cells, which are either seminomas, or non-seminomas. Seminomas cancers are slow growing and tend to be localized to one area in the testes. Non-seminomas cancers are more cancerous and metastasize (spread) quickly to other parts of the body. When both tumors are present, the cancer is categorized as nonseminomas. Development stages - Testes cancer Nonseminomas cancers can be categorized and diagnosed into three development stages, with Stage 1 being the most common and easily treatable: Stage 1, localized cancer development in the testes; Stage 2, the cancer has spread to the nearest lymph nodes in the abdomen; and, Stage 3, the cancer has spread to other organs, for example, lungs, kidneys, and brain. Testes cancer has one of the highest cure rates among all cancers treated in men if diagnosed during the early stages of disease development. Cure rates are over 90% with effective diagnosis and treatment. Risk Factors The cause of testes cancer is unknown. In some case, genetic factors seem to predispose men to this cancer. Men with a history of congenital testicular defects, for example, cryptorchid (undescended) testes have a higher risk of developing the cancer. Other predisposing factors may include a history of mumps and certain types of hernia developing in childhood. However, in the majority of cases, no predisposing or causal relationships can be identified. Symptoms The most common symptom of testes cancer is painless enlargement of the testes. A testicular mass or enlargement is found in majority of cases. Sensations of heaviness are also common. Other symptoms may include: blood in seamen during ejaculation, abdominal or groin pain, or fluid build-up in the scrotum. Diagnosis Most testes cancers are diagnosed with detection of the above symptoms. Thus, regular physical examinations are essential for early detection and effective treatment

outcomes. After testes cancer has been detected, additional testing is required to confirm the initial diagnosis, staging and type cancer, and whether it has metastasized. Other examinations include CT scans, X-rays, blood and laboratory tests, and assessment of biologic markers. http://www.oconnelloncology.com/testes-cancer/ Testicular cancer Testicular cancer occurs when abnormal cells in the testicles divide and grow uncontrolled. Testicular cancer can develop in one or both testicles in men or young boys. Symptoms of testicular cancer include a lump, irregularity or enlargement in either testicle; a pulling sensation or feeling of unusual heaviness in the scrotum; a dull ache in the groin or lower abdomen; and pain or discomfort (which may come and go) in a testicle or the scrotum. The exact causes of testicular cancer are not known, but there are certain risk factors for the disease. A risk factor is anything that increases a persons chance of getting a disease. The risk factors for cancer of the testicles include:
y y

y y

Age Testicular cancer can occur at any age, but most often occurs in men between the ages of 15 and 40. Undescended testicle (cryptorchidism) This is a condition in which the testicles do not descend from the abdomen, where they are located during development, to the scrotum shortly before birth. This condition is a major risk factor for testicular cancer. Family history A family history of testicular cancer increases the risk. Race and ethnicity The risk for testicular cancer in Caucasian men is more than five times that of African-American men and more than double that of AsianAmerican men.

Testicular cancer is a rare form of cancer, and is highly treatable and usually curable. Surgery is the most common treatment for testicular cancer. Surgical treatment involves removing the cancerous testicle through an incision (cut) in the groin. In some cases, the doctor also may remove some of the lymph nodes in the abdomen. Radiation, which uses high-energy rays to attack cancer, and chemotherapy, which uses drugs to kill cancer, are other treatment options. The success of treatment for testicular cancer depends on the stage of the disease when it is first detected and treated. If the cancer is found and treated before it spreads to the lymph nodes, the cure rate is excellent, greater than 98 percent. Even after testicular cancer has spread to the lymph nodes and other parts of the body, chemotherapy is highly effective, with a cure rate greater than 90 percent.

To prevent testicular cancer, all men should be familiar with the size and feel of their testicles, so they can detect any changes. The American Cancer Society recommends monthly testicular self-examinations (TSE) for men over age 15. A TSE is best performed after a warm bath or shower, when the skin of the scrotum is relaxed. After looking for any changes in appearance, carefully examine each testicle by rolling it between the fingers and thumbs of both hands to check for any lumps.

Testicular Cancer - Topic Overview

What is testicular cancer?

Testicular cancer occurs when cells that are not normal grow out of control in the testicles (testes). It is highly curable, especially when it is found early. The testes are the two male sex organs that make and store sperm . They are located in a pouch below the penis called the scrotum. The testes also make the hormone testosterone. Testicular cancer is most common among white males. It is not common in men of African or Asian background.1 Although rare, testicular cancer is the most common form of cancer in men between the ages of 20 and 34.2
What causes testicular cancer?

Experts don't know what causes testicular cancer. But some problems may increase your chances of getting it. These include:1, 3
y

Having a testicle that has not dropped down into the scrotum from the belly. This is called an undescended testicle. Normally, a baby s testicles drop down into his scrotum before he is born or by the time he is 3 months old. Klinefelter syndrome. This is a genetic problem that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four. A family history of testicular cancer.

Most men who get testicular cancer don't have any risk factors.
What are the symptoms?

The most common symptoms of testicular cancer include:

y y y

A change in the size or shape of one or both testes. You may or may not have pain. A heavy feeling in the scrotum. A dull pressure or pain in the lower back, belly, or groin, or in all three places.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves during a self-examination find it during a routine physical exam.

. Or your doctor may

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT or CAT scan. These tests can also help find out if cancer has spread to other parts of your body.
How is it treated?

Nearly all men with testicular cancer begin treatment with surgery to remove the testicle that has cancer. This surgery is called radical inguinal orchiectomy. Removing the testicle allows your doctor to find out the type of cancer cells you have. It also helps him or her plan any other treatment you may need. Treatment after surgery may include:
y y y

y y y

Watchful waiting. You may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to make sure that the cancer is gone. Chemotherapy. This is powerful medicine that destroys any cancer cells that remain after surgery. Radiation therapy. This is a high dose of X-rays used to destroy cancer cells. It is mostly used to treat a kind of cancer called seminoma, but it is sometimes used after surgery to kill leftover cancer cells. Radiation therapy can also be used to treat cancer that has spread beyond the testes. Additional surgery to remove lymph nodes. This surgery is called retroperitoneal lymph node dissection (RPLND).

Chemotherapy is often used for cancer that has spread to other parts of the body. In some cases, surgery is used to remove that kind of cancer. Testicular cancer is highly curable when it is found early. Even when it is found at an advanced stage, it is considered very curable.
How will having testicular cancer affect you?

y y

y y

In most cases, removing a testicle does not cause long-term sexual problems or make you unable to father children. But if you had these problems before treatment, surgery may make them worse. Also, other treatments for cancer may cause you to become infertile. You may want to think about saving sperm in a sperm bank. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can father children. Some men choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals. Unlike many other kinds of cancer, most testicular cancers grow slowly and respond well to treatments such as chemotherapy and radiation therapy. But these treatments can cause side effects. Most of the time, the side effects last only a little while, but there also are longer-term side effects from treatments.

http://www.webmd.com/cancer/tc/testicular-cancer-topic-overview

Testicular Cancer
What is testicular cancer? Testicular cancer is a cancer of the sperm producing cells and is the most common cancer in younger men from puberty until approximately 50 years of age. After 50 years of age, testicular cancer is very rare. Testicular cancer is usually discovered because the man feels a lump or heaviness of the testis. Often this is discovered during self examination while showering. Any change in the testes is worth getting checked. What causes testicular cancer? In most cases of testicular cancer the causes are unknown. Testicular cancer risk is higher in men when there has been any problem with the testes coming down into the scrotum (undescended testes). It is also slightly more common in men with a fertility problem and also more common in the opposite testis if the man has already had a previous testicular cancer. What are the treatments? Treatment is to remove the testis which contains the cancer. Scans are done to check that the cancer has not spread. Depending on the type of testicular cancer and the scan results, there may be a need for additional treatment with cancer chemotherapy (anticancer medicines) or radiotherapy. Contact Andrology Australia for a free copy of its consumer guide Testicular Cancer: lumps and self examination.

What is Testicular Cancer?

Testicular cancer, also known as cancer of the testes, occurs when germ cells (the cells that become sperm) experience abnormal growth. Germ cells, like stem cells, have the potential to form any cell in the body. Normally this ability is dormant until the sperm fertilizes an egg. When germ cells become cancerous, they multiply unchecked, forming a mass of cells called a tumor, and invade normal tissue.

Testicular cancer can metastasize, meaning that it can spread to other parts of the body. During metastasis cells leave the original tumor and migrate to other parts of the body through blood and lymph vessels, forming a new tumor. Testicular cancer metastasis most often involves the abdomen, lungs and brain. Testicular cancer can spread rapidly and is

deadly if left untreated. Testicular cancer has a very fast onset. Testicular cancer grows rapidly, with tumors doubling in size in just 10 to 30 days. There are two main types of testicular cancer: seminomas and non-seminomas.
y

Seminomas involve a uniform type of cell and spread less aggressively. Approximately 40% of testicular cancers are seminomas. When testicular cancer is first diagnosed, threequarters of seminoma cases have not spread beyond the testes. Non-seminomas involve a mixture of cell types, and are much more aggressive than seminomas. When testicular cancer is first diagnosed, two-thirds of non-seminoma cases have already spread to the lymph nodes.

Luckily, germ cell tumors involve relatively primitive cells, making them more susceptible to treatment. This is why testicular cancer has one of the highest cure rates of any cancer. Testicular cancer is a relatively rare form of cancer, representing about 1% of cancers affecting men. However, it is the most common form of cancer between the ages of 15 and 44. 78.7% of testicular cancer cases occur in men between the ages of 20 and 44 and 90.4% between the ages of 20 and 54. It is estimated that there will be 8,980 new cases of testicular cancer in 2004, and 360 deaths. Testicular cancer incidence rates have been increasing steadily by about 2.1% per year, from 3.3 cases per 100,000 persons in 1974 to 4.0 per 100,000 persons in 1984 to 4.9 cases per 100,000 persons in 1994 and 6.1 cases per 100,000 persons in 2000. At the same time, mortality rates have been dropping. In 1950-54 the five-year survival rate was 57%. This improved to 63% in 1963, 79% in 1974-76, 91% in 1983-85, and 95% in 1992-98. The decline in mortality rates is primarily due to the introduction of more effective treatments, such as the BEP (bleomycin, etoposide and cisplatin) chemotherapy regimen. Testicular cancer is much more common among white men than black, hispanic, asian and native american men, with 93% of testicular cancers occuring in white men. Five-year survival rates are highest among white men, but overall prognosis for all races is good. (The median age of testicular cancer patients at diagnosis is 34 for white men ant 43 for black men. Black men have 10% fewer stage I cases than white men, and 2% more stage II and 8% more stage III. This probably accounts for the differences in survival rates.) Incidence rates are higher in more developed countries, and also increase with socio-economic status. The lifetime risk of being diagnosed with testicular cancer is 0.35%. The lifetime risk for white men is 0.42% and for black men it is 0.10%. The lifetime risk of dying of testicular cancer is 0.02%. Testicular cancer is not contagious.