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Testicular tumors in the pediatric patient
Hannah Jarvis1, Nicholas G Cost2, Amanda F Saltzman1
1Department of Urology, University of Kentucky, 800 Rose St., MS237, Lexington, KY 40536, USA.
Seminars in Pediatric Surgery
|August 20, 2021
Summary
Testicular cancer presentation and outcomes vary by age, with prepubertal males often having benign disease. Post-pubertal patients typically have malignant masses, requiring different management strategies for optimal outcomes.
Area of Science:
- Pediatric Oncology
- Urologic Oncology
- Cancer Biology
Background:
- Testicular cancer is a rare malignancy with outcomes influenced by patient age, particularly pubertal status.
- Prepubertal males (< 11 years) are more likely to have benign testicular masses, while post-pubertal males predominantly present with malignant disease.
- Factors like race, family history, and personal medical history also impact malignancy risk.
Purpose of the Study:
- To review the diagnostic and management strategies for testicular cancer in pediatric and adolescent populations.
- To highlight the importance of pubertal status in guiding treatment decisions and predicting outcomes.
- To emphasize the role of serum tumor markers, histology, and imaging in diagnosis and staging.
Main Methods:
- Review of histopathologic features, treatment protocols, and outcomes based on age at presentation.
- Evaluation of serum tumor markers (STM) and histologic findings for diagnosis and management.
- Assessment of cross-sectional imaging for staging purposes.
- Discussion of surgical approaches including testis-sparing surgery and radical orchiectomy.
- Consideration of surveillance protocols and adjuvant therapy.
Main Results:
- Normal STMs in prepubertal patients may allow for testis-sparing surgery.
- Radical orchiectomy is the standard for post-pubertal patients, irrespective of STM levels.
- Cross-sectional imaging is crucial for staging, with timing dependent on the clinical situation.
- High survival rates are achievable, with low-stage disease often managed effectively with surveillance.
- Adjuvant therapy, when needed, requires a multidisciplinary team approach.
Conclusions:
- Pubertal status is a critical determinant in the evaluation and management of testicular cancer.
- Tailoring treatment protocols based on pediatric versus adult guidelines, considering pubertal status, is essential for optimal oncologic outcomes.
- A multidisciplinary approach ensures comprehensive care and improves patient outcomes.
