Testicular Cancer in Children: Risks, Symptoms, and Early Detection

Epidemiology

• Testicular cancer is rare in children (<2% of all childhood cancers).
• Peak incidence: ages 15–35 (adolescents/young adults).
• Prepubertal cases: ~1–2 per million boys/year; median age ~10–12 if occurs.
• Histology differs: Yolk sac tumor (endodermal sinus tumor) predominates in infants/children; Germ cell tumors (seminoma, non-seminoma) dominate post-puberty.

Risk Factors

• Cryptorchidism (undescended testis): 3–5x risk; orchiopexy before puberty reduces but doesn't eliminate.
• Family history (father/brother).
• Genetic syndromes: Klinefelter (47,XXY), Down syndrome, gonadal dysgenesis.
• Prior testicular cancer (contralateral risk 2–5%).

Symptoms

• Painless testicular lump/swelling (most common).
• Heaviness, ache in scrotum or groin.
• Acute pain (if hemorrhage/infarction in tumor, or torsion).
• Gynecomastia (hCG-secreting tumors).
• Precocious puberty (Leydig cell tumors → testosterone).

Evaluation

1. Scrotal ultrasound (first-line; 100% sensitivity for intratesticular mass).
2. Serum tumor markers: AFP (yolk sac, embryonal), β-hCG (choriocarcinoma, seminoma), LDH (bulk).
3. CXR / CT chest/abdomen/pelvis for staging.
4. Inguinal radical orchiectomy = diagnostic + therapeutic (never transscrotal biopsy).

Treatment and Prognosis

• Children: Surgery + risk-adapted chemo (cisplatin-based). Excellent outcomes: >95% 5-year survival for low/intermediate risk.
• Fertility preservation: Sperm banking (adolescents); testicular tissue cryopreservation (prepubertal, experimental).
• Long-term surveillance: Markers, imaging, cardiovascular/renal/hearing toxicity monitoring.

Key Message for Parents

Teach boys monthly testicular self-exam from puberty. Any lump, swelling, or change — see a doctor promptly. Early detection = curable.