Testicular Cancer

Testicular germ cell tumors arise from embryonic primordial germ cells. Seminomas contain relatively uniform cells resembling those primitive germ cells. Non-seminomas are a group of tumors that may contain embryonal carcinoma, yolk-sac tumor, choriocarcinoma, teratoma, or mixed elements. That distinction affects both marker interpretation and treatment planning. Alpha-fetoprotein (AFP) elevation indicates a non-seminomatous component; a pure seminoma does not produce AFP. Beta-human chorionic gonadotropin (β-hCG) can be elevated with seminoma or choriocarcinoma. Lactate dehydrogenase (LDH) is less specific, but a marked elevation can reflect greater tumor burden. The classic presentation is a firm, unilateral intratesticular mass that is painless or causes only a feeling of heaviness. The tumor often enlarges without the inflammatory irritation that produces tenderness, which explains why a patient may delay seeking care. Pain does not exclude cancer, but sudden severe pain changes the priority: testicular torsion must be treated as an emergency.