Testicular cancer

The rising rate of germ cell cancer of the testis over the past decade has been demonstrated to be occurring predominantly in the younger age group (15 to 19 years) in association with earlier onset of puberty and earlier onset of regular sexual activity. Chemicals and viruses, with their atrophogenic effect, remain the main candidates for inducing the final common pathway of tumor development and clonal evolution, ie, gonadotropin-driven mitosis in spermatogonia. The possibility of different genetic mechanisms regulating susceptibility and resistance to these two extreme causes of gonadal atrophy in families is raised by the failure of a genome screen in a series of sibling pairs with testicular cancer to identify a single significant linkage group. Studies demonstrating high levels of non-mutated p53 protein and rapid induction of apoptosis by chemotherapy provide a new insight into the cause of the exquisite chemosensitivity of these tumors. Durable responses to paclitaxel and in vitro activity in response to temezolamide provide further evidence of the plethora of agents that work against these tumors, although no new first-line therapeutic approaches have been reported recently. The most important clinical trial studied good-risk patients and demonstrated that to gain the benefit of reducing treatment time from 12 to 9 weeks it is essential to retain bleomycin in the BEP (bleomycin, etoposide, and cisplatin) regimen. The final new idea to emerge recently comes from a series of papers on management of primary tumors in patients with a solitary testis and the possible use of organ-conserving surgery plus postoperative radiation. Another study did suggest it might be possible to use preoperative chemotherapy in those wishing to retain spermatogenesis.