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Germ cell testicular tumours (GCT) are the most common tumours found in men. Average age of diagnosis is 30 year of age and are rarely diagnosed pre-puberty. Risk factors for development include cryptorchidism and a positive family history of GCT. Familial GCT increased risk can be linked to genes encoding for kinases, e.g. KIT and BAK.
They can be divided into two groups: seminomatous (resemble primordial germ cells) and non-seminomatous (resemble embryonic stem cells). Over one third of GCT are mixed GCT, with two or more GCT types in one mass. Many possible combinations of seminoma, teratoma, embryonal carcinoma, yolk sac tumor, and choriocarcinoma can be seen. Teratomas components are found in one third of mixed GCT. Elevated serum Alpha Fetoprotein and beta-hCG are produced by choriocarcinoma. Lymphatic spread involves the retroperitoneal para aortic nodes initially. Mediastinal and supraclavicular nodes may later become involved. The lungs are the most common site for haematogenous spread but the liver, brain or bones may also be affected.
Symptoms may include a painless testicular mass and haematospermia. Later symptoms of distant metastases may occur. Common symptoms of lung metastases include cough, dyspnoea, haemoptysis, recurrent infection.
Treatment depends on clinical stage but usually involves radical orchiectomy, chemotherapy and sometimes radiotherapy. More than 95% on early stage GCT can be cured.
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