Article

Trends in testicular carcinoma in England and Wales, 1971-99

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Abstract

To examine incidence, mortality and survival trends in England and Wales for testicular cancer, using the recently developed national cancer and national mortality databases. The directly age-standardized incidence rates for testicular cancer in England and Wales were calculated for the period 1971-97 and age-standardized mortality for years 1971-99. Trends in the data were then assessed, including the influence of social deprivation on testicular cancer incidence and survival. The number of newly diagnosed cases of testicular carcinoma in 1971-97 in England and Wales increased from almost 650 to 1400. The age-standardized rates were 2.9 per 100000 cases in 1971 and 5.4 per 100000 in 1997, an increase of 88% over 26 years. There was a large decrease in mortality since the mid-1970s, with an age-standardized mortality of < 0.5 per 100000 since 1985. For men with testicular carcinoma diagnosed in 1991-93, the 1-year relative survival was almost 98% and 5-year relative survival almost 95%, compared with 82% and 69%, respectively, for men diagnosed during 1971-75. There is a 'deprivation gap' for the 5-year survival of > 6% in favour of the most affluent socio-economic group, with no significant change over recent years. The incidence of testicular cancer is increasing in England and Wales, consistent with the trend documented in other developed countries. The reduction in mortality has been marked since the mid-1970s, reflecting improved cancer management, in particular the introduction of platinum-based chemotherapy regimens for advanced disease. Survival rates in England and Wales are as good as in other European countries. Further developments in chemotherapy are unlikely to produce such a marked improvement in survival rates again, and minimizing the effect of social status on survival rates should be an important target of future care.

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... Non-neoplastic lesions includes cryptorchidism, atrophic testis, testicular torsion, infertility, infections like acute/chronic granulomatous orchitis like tuberculosis in developing countries like India [1]. Malignant tumors of testis comprise 1% of all the male cancers worldwide [2]. Geographical and racial distribution is observed in malignant tumors of testis with distinct age distribution compared to other malignancies [3]. ...
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Introduction:Testicular lesions are ranges from varied spectrum of non-neoplastic to neoplastic ones with diverse etiologies. Non-neoplastic testicular lesions usually preceded by neoplastic ones. The malignant tumors of testis constitute fourth most common cause of death in young males. Objectives:The present study was undertaken to study varied spectrum of neoplastic and non-neoplastic lesions of testis in our tertiary care institute with emphasis on study of histomorphological patterns of testicular tumors.Material and Methods-Our study was a retrospective, descriptive and observational study over a period of 6 years from May 2015 to April 2021 in our tertiary care centre. We received 60 orchidectomy specimens over a study period. Histopathological slides were collected and reviewed for specific tumor/non-tumor category and results were analyzed.Results-We studied 60 orchidectomy specimens over a period of six years. As per age groups distribution, the childhood predominates in non-neoplastic category and 2 nd to 4 th decade in malignant category. Out of 60 cases (100%), majority (57%) were malignant testicular tumors. In the malignant category, non seminomatous germ cell tumor (56%) were most frequent finding with mixed germ cell tumor (68%) as predominant histopathological diagnosis. Leydig cell tumor and pure yolk sac tumor was rare findings. In non-neoplastic category, vascular causes (61%) like torsion, ischemic necrosis were major findings. Epidermoid inclusion cyst, acute and chronic orchitis, atrophy are rare findings. Conclusion-Neoplastic lesions were preceded by non-neoplastic lesions in our study. Variable testicular tumors were encountered in present study as per different age groups. Histopathological spectrum of testicular lesions was comparable with other parts of the country. We highlight the role of histopathological examination of each resected orchidectomy specimens as it's most important to diagnosis and rule out malignant tumors.
... Testicular neoplastic lesions are noted as most common neoplasms between 2 nd and 4 th decades of life. 2,3 Testicular and para testicular neoplasms are classified into various subgroups by World Health Organization (WHO) in 2004. 4 The predisposing risk factors for the development of testicular tumours are cryptorchidism, infertility, Klinefelter's syndrome, family history of testicular tumour in 1 st degree relatives, trauma, hormones, etc. 5 We wanted to evaluate the histopathological patterns of various testicular lesions and to study the distribution of nonneoplastic and neoplastic lesions of testis among different age groups. ...
Article
BACKGROUND The incidence of testicular malignancy has been increasing in men, orchidectomy is necessary for the removal of neoplastic lesions or in patients with chronic inflammatory conditions resistant to treatment. We wanted to evaluate the various histopathological patterns of lesions in testis. METHODS A retrospective study of 86 orchidectomy specimens over a period of three years with age wise distribution from March 2017 to February 2020 was done in the Department of Pathology, Guntur Medical College, Guntur. Histopathological slides stained with haematoxylin and eosin were retrieved and reviewed. Immunohistochemistry was done in two cases. RESULTS Of the 86 cases, 78 (90.7 %) cases were non neoplastic and 8 (9.3 %) cases were neoplastic. Youngest age in non-neoplastic group was four days and in neoplastic group was 18 years. The oldest age was 82 years in the non-neoplastic lesions and 60 years in the neoplastic lesions. Non neoplastic lesions were common in the 3 rd decade. In malignant lesions, highest number of cases was seen in the 6 th decade and equal distribution was observed in 3rd and 5th decade. Unilateral involvement was common than bilateral involvement. Out of all non-neoplastic lesions, undescended testis 20 (25.64 %) cases was the common finding followed by non-specific epididymo orchitis 19 (24.36 %) cases, abscess 14 (17.95 %) cases, torsion infarction 13 (16.67 %) cases, Leydig cell hyperplasia 4 (5.13 %) cases, 3 (3.85 %) cases each of tuberculous epididymo orchitis and granulomatous epididymo orchitis. 1 (1.28 %) case each of rare entities like vanishing testis and splenogonadal fusion were also found. Among the neoplastic lesions, all 8 cases were malignant tumours. Out of these malignant tumours, mixed germ cell tumours were seen in 3 (37.5 %) cases followed by seminomas 2 (25 %) cases, post pubertal teratoma 1 (12.5 %) case, non-Hodgkin’s lymphoma (NHL) 1 (12.5 %) case and primitive neuroectodermal tumour (PNET) 1 (12.5 %) case. CONCLUSIONS Histopathological examination on routine haematoxylin and eosin (H&E) stained sections primarily differentiate non neoplastic lesions from neoplastic group and benign tumours from malignant tumours as the treatment modality varies. Immunohistochemistry (IHC) is useful in the diagnosis of poorly differentiated small round cell tumours.
... 1 Testicular tumors are most commonly encountered in 15-35 years age group. 2 In western countries incidence of these tumors is on rising trend. 3 However, in India, its incidence is low i.e. 15.92%. ...
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Background: Testicular and paratesticular neoplasia are rare type of tumors affecting adolescents and young adults in India, as observed by paucity of published data. This study was undertaken to analyze the patterns of testicular tumors at a tertiary level hospital in Kashmir valley, Jammu and Kashmir, India highlighting the patient’s demography, clinical presentation, diagnostic evaluation and pathological finding.Methods: This 5-year (retrospective and prospective) study was performed in the Department of Pathology, Government Medical College Srinagar, Jammu and Kashmir, India from January 2012 to December 2016. For the retrospective study, all cases of testicular tumors, their histopathological reports and required clinical details were searched from records maintained in the Department of Pathology, GMC Srinagar, Jammu and Kashmir, India. For the prospective study, the orchiedectomy specimens received in our department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumour typing and subtyping was done according to WHO classification (2004).Results: A total of 37 cases of testicular and paratesticular neoplasia were included in present study with a mean age of 35.1 years. Out of these 37 cases, 31 (83.78%) were malignant and 6 cases (16.22%) were benign. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling. Germ cell tumor was the most common type accounting for 89.2% of tumors followed by lymphomas (8.1%).Conclusions:It is concluded that despite new techniques in imaging and tumor marker assay, the diagnosis of testicular tumors is dependent upon histopathological examination. The present study fairly provides an insight into the clinical presentations, prevalence and patterns of testicular tumors.
... Among European countries there is a 7 times difference in the incidence rate of TC [6]. The mortality rate from TC in the past 50 years has decreased in developed countries such as Denmark [7], England, wales [8] and Scotland [9]. But the reduction in the mortality rate of TC is not observed in the countries of west, central and east Europe [10]. ...
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Article
Testis Cancer (TC) is the most common cancer in 15-39 year-old men and with the white Caucasian race. This cancer consists of 0.7 percent of men's cancer all over the world. The aim of this study is to investigate the relationship between the Age-Standardised Incidence Rates (ASIR) and Age-Standardised Mortality Rates (ASMR) of TC with Human Development Index (HDI) and its components at the European countries in 2012. This study was an ecologic study in European countries for assessment the correlation between ASIR and ASMR with HDI and its details including: Life expectancy at birth, Mean years of schooling and Gross National Income (GNI) per capita. We use correlation bivariate method for assessment the correlation between SIR and SMR with HDI and its components. Data of study was analyzed by SPSS15statistical analysis software; the significance level of the tests was considered P˂0.05. The results of the data investigation showed that the maximum ASIR of TC was observed respectively in the countries of Norway, Switzerland, and Denmark. Moreover findings showed the highest ASMR was in the countries of Hungary, Bulgaria and FYR Macedonia. The ASIR was positively correlated with HDI equal to 0.623(p≤0.001), with Life expectancy at birth equal to 0.602(p≤0.001), with the average years of schooling equal to 0.339(p=0.032) and with country's Gross National Income (GNI) per capita equal to 0.466(p=0.002).The ASMR was negatively correlated with HDI equal to 0.537(p≤0.001), life expectancy at birth equal to
... [2] They constitute the most common solid malignancies in men aged between 15 and 34 years. [3] Whereas the incidence is rising in the Western and Asian countries, the incidence in the Black populations of Africa and West Indies is low. [4,5] The testes are a major source of testosterone in the male, contributing about 95% of total serum testosterone. ...
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Background: Testicular biopsy is an acknowledged method of examination of the testes for diagnostic and therapeutic purposes. We describe the pattern of testicular histologies in our environment. Materials and Methods: We carried out a retrospective review of testicular histology results from the Pathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a 5-year period, January 2008 to December 2012. Results: During the period, 285 testicular histologies were reported. Eighty-one (28.4%) specimens were pathological specimens, while 204 (71.6%) were nonpathological specimens. Thirty-seven (13.0%) of the histology reports were for diagnostic purpose while 248 (87.0%) were for therapeutic purpose. Based on the results, indications could also be categorized into three, benign testicular pathology, malignant testicular pathology, and testicular biopsy for male factor infertility. Thirty-seven cases (13.0%) were due to male factor infertility with complete spermatogenic arrest as the most common histological finding in 21 (56.8%) of the cases. Malignant testicular diseases accounted for 16 (5.6%) of the indications for testicular biopsies. Benign testicular diseases accounted for 28 (9.8%) of the indications for testicular biopsies. Hemorrhagic infarction from testicular torsion represented the commonest histology in 12 (42.9%) cases, followed by inflammations of the testes. Conclusion: Indications for testicular biopsy can be diagnostic and therapeutic. They can also be categorized into benign testicular diseases, malignant testicular diseases, and male infertility. Investigation for male factor infertility was the only diagnostic indication for testicular biopsy. The high incidence of locally and metastatic prostate cancer in males explains why therapeutic removal of the testis is common.
... The incidence of testicular cancer is rising. Over the last 25 years, age standardised rates in England and Wales have increased by 88% [4]. The vast majority of these tumours are palpable, the diagnosis then confirmed with ultrasonography. ...
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Article
Gynaecomastia is the most common benign breast disorder in men. Among the various causes, testicular malignancies are an uncommon, life-threatening condition requiring prompt diagnosis and treatment. The case of a 28-year-old man is discussed, who presented with a 6-month history of painful bilateral gynaecomastia with no abnormality on clinical or biochemical examination. The patient's symptoms spontaneously resolved within 4 weeks. He then represented 10 years later with similar symptoms and an associated secondary hypogonadism. Ultrasound imaging revealed a clinically occult, hypoechoic mass in the left testis (Leydig cell tumour on histology). Clinical and hormonal findings normalized following surgical excision. This report underlines the importance in clinical practice of ultrasonographic evaluation of the testis, in all patients with gynaecomastia, despite unremarkable findings on physical examination.
... Many previous studies reported relative survival (RS) of testicular cancer. However, many reports did not even distinguish between seminoma and nonseminoma and also included testicular tumors other than germ cell tumors [1,2,[5][6][7][8][9][10][11][12][13]. Some studies distinguished by histology but only in broad terms by providing separate RS estimates for seminoma and nonseminoma [14][15][16][17][18][19]. ...
Article
Introduction: The aim of this study was to provide detailed age-specific (5-year age groups) and histology-specific (histologic subtypes of seminoma and nonseminoma) relative survival estimates of testicular germ cell cancer patients in Germany and the United States (U.S.) for the years 2002-2006 and to compare these estimates between countries. Methods: We pooled data from 11 cancer registries of Germany and used data from the U.S. (SEER-13 database) including 11,508 and 10,774 newly diagnosed cases (1997-2006) in Germany and the U.S., respectively. We estimated 5-year relative survival (5-year-RS) by histology and age based on period analysis. Results: 5-year-RS for testicular germ cell tumors was 96.7% and 96.3% in Germany and the U.S., respectively. 5-Year-RS for spermatocytic seminoma was close to 100% in both countries. 5-Year-RS for nonseminoma was lower than for classical seminoma in Germany (93.3% versus 97.6%) and the U.S. (91.0% versus 98.2%). Among nonseminomas, choriocarcinomas provided the lowest 5-year-RS in both countries (Germany 80.1%, U.S. 79.6%). Age-specific 5-year-RS for seminoma showed only little variation by age. 5-Year-RS for nonseminomas tended to be lower at higher ages, especially for malignant teratoma. Discussion: This is the first study that provides up-to-date survival estimates for testicular cancer by histology and age in Germany and the U.S. Survival after a diagnosis of testicular cancer is very comparable between Germany and the U.S. 5-Year-RS for spermatocytic seminoma was close to 100% and the lowest 5-year-RS occurred among choriocarcinoma. Higher age at diagnosis is associated with a poorer prognosis among nonseminoma patients.
... Testicular cancer accounts for about 1% of cancers in men, with increase in the incidence over some last decades. 1 The peak incidence occurs in men aged 25-35 years. However, despite the rise in incidence, mortality from testicular cancer has fallen the overall cure rate is now over 90%. 2 Maldescent predisposes to malignancy. ...
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About 99% of testicular tumors are malignant though they only constitute about 1-2% of malignant tumors in male. They are more readily accessible to examining fingers than a tumour of any other organ in the body, however too often they escape detection until it has metastasised. Worst error is to plunge a trocar and cannula into the enlarge testis or operating from scrotal approach in the belief that it is a hydrocele. Proper pre-operative assessment and diagnosis has the key role in the life expectancy of patient. Hydrocele and testicular tumor both have different operative approaches. For hydrocele scrotal approach and for tumor inguinal approach is recommended. For tumor, if scrotal approach has been adapted it may result in disaster. Two cases of testicular carcinoma initially diagnosed and operated as cases of hydrocele are reported.
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Silverberg's Principles and Practice of Surgical Pathology and Cytopathology is one of the most durable reference texts in pathology. Thoroughly revised and updated, this state-of-the-art new edition encompasses the entire fields of surgical pathology and cytopathology in a single source. Its practice-oriented format uniquely integrates these disciplines to present all the relevant features of a particular lesion, side by side. Over 4000 color images depict clinical features, morphological attributes, histochemical and immunohistochemical findings, and molecular characteristics of all lesions included. This edition features new highly experienced and academically accomplished editors, while chapters are written by the leading experts in the field (several new to this edition, bringing a fresh approach). Dr Steven Silverberg's practical approach to problem solving has been carefully preserved. The print book is packaged with access to a secure, electronic copy of the book, providing quick and easy access to its wealth of text and images.
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Although weighing only about 19 grams, the testis is responsible for a complex array of neoplasms. The rapidly proliferating spermatogenic cells give rise to the majority of testicular tumors, 95% of which are of germ cell derivation. Most are malignant and usually occur in young men, but they can be cured by current therapies; therefore accurate diagnosis is essential. The supporting cells and interstitial cells of the testis are responsible for the less common sex cord–stromal tumors that compose a disproportionate number of diagnostic problems. Some of these are associated with clinical syndromes that may be suspected based on the testicular pathology. A number of tumors of soft tissue origin may be identified in the paratestis, and secondary tumors are relatively frequent in both the testis and paratestis. The spectrum of lesions and the capacity of many tumors to mimic others make testicular neoplasia a continuing challenge to surgical pathologists, and this topic has been the subject of several recent reviews.
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p> Background : Testicular tumors are rare type of tumors affecting adolescents and young adults. The testicular tumors constitute 4<sup>th</sup> most common cause of death from neoplasm in a younger male.The present study is undertaken to analyze the pattern and age wise distribution of testicular lesions in our hospital. Materials and methods : This was a prospective study done over a period of 4 years from November 2012 to October 2016, after taking approval of the ethics committee and informed consent from the patients. Histopathological slides were retrieved and reviewed for tumor and its subtype. Results : A total of 60 cases of testicular lesions were encountered in our study. Out of the total 60 cases,15% (9/60) were diagnosed as malignant testicular tumor.Most of these tumors were seen between 3<sup>rd</sup> and 4<sup>th</sup> decades.Germ cell tumor was the most common type (77.7%) among which seminomas (44.44%) and mixed germ cell tumors(28.57%) were most frequently encountered.Other tumor diagnosed was Non-Hodgkin lymphoma. Non-neoplastic lesions of the testis are most common in the second decade of life. The youngest patient was at birth and oldest was 71 years of age. Out of all non-neoplastic lesions, vascular lesions like torsion and infarction are the most common findings (54.90%) followed by tuberculous abscess (15.68%). Conclusion : Testicular tumors are uncommon in our population. Histopathological spectrum of our study was comparable with other parts of the world,germ cell tumor accounted for highest percentage of cases in neoplastic lesions and torsion and infarction are the common findings in non-neoplastiic lesions of testis.</p
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Introduction: Testicular and para-testicular neoplasm are rare type of tumours affecting adolescents and young adults, reflected by the paucity of published data in India. Aim: This study was undertaken to estimate the epidemiological characteristics and histological types and subtypes of testicular neoplasm according to the WHO classification in our patient group. Identification of histopathological pattern of testicular tumour is immensely important for improved management protocols. Materials and methods: This was a retrospective study done over a period of ten years from 2004 to 2014 in a tertiary care centre. All relevant clinical data including patient's age, laterality, history of risk factors and serum tumour markers were collected from records. Histopathological slides were retrieved and reviewed for tumour and its subtype and classified according to WHO classification (2004). Results: A total of 37 cases of testicular and paratesticular neoplasm were encountered in our study with a mean age of 38.1 years. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling with heaviness. Germ cell tumour was the most common type accounting for 77.1% followed by lymphomas (17.1%). Germ cell tumours were categorized into seminomatous (48.2%) and non-seminomatous tumours (51.8%). The most common subtype of non-seminomatous tumours was mixed germ cell tumour accounting for 85.8%. Conclusion: The incidence of testicular neoplasm among general population in Asian countries is low, as reflected in the very few studies that have been performed and published in literature. Epidemiological and histomorphological spectrum of our study was comparable to most of the countries except for some African and Western countries.
Article
Background: Despite the fact that testicular cancer is a major health issue with its increasing incidence, very few studies have described its characteristics in the Middle East, particularly in Lebanon. Materials and Methods: We report in this paper a retrospective pilot study of the characteristics of testicular cancer in Lebanon. The demographic, epidemiologic and survival characteristics of 178 patients diagnosed between 1990 and 2015 at an oncology clinic affiliated to Hotel Dieu de France Hospital were analyzed. Results: The mean age at diagnosis was 32 ±10 years. The most prevalent testicular tumor was the germ cell type (GCT) (95.2%) of which non-seminomatous tumors (NST) were the commonest (64.7%). Most of our patients were diagnosed at an early stage. Lymph node spread affected most commonly the retroperitoneal region and distant visceral metastases occurred in 14.6%. All patients underwent orchiectomy with 67% receiving adjuvant treatment, mainly chemotherapy. After a median follow up of 2,248 days (75.9 months) 16 patients were reported dead. Two, five and ten-year overall survival rates were 96%, 94% and 89% respectively. The median overall survival rate was not reached. Conclusions: Despite being part of the developing world, demographic, epidemiologic and survival analyses of testicular cancer reported in our study are in line with those reported from developed countries and would allow us to extrapolate management plans from these populations.
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Purpose To assess the prevalence of intratubular germ cell neoplasia (ITGCN) in patients with concurrent testis tumor and its correlation with histologic features and serum tumor markers. Materials and Methods From 2003 to 2015, 179 patients underwent radical orchiectomy due to testicular mass. Tissue specimens were evaluated by an expert uro-pathologist using immunohistochemistry (IHC) staining, in addition to light microscopy, to identify presence of ITGCN. Patients' demographic characteristics, histologic subtypes, pathologic stage of tumor and serum tumor markers were gathered and analyzed. Results Eighty-five out of 179 patients (47.5%) had concomitant ITGCN according to IHC staining. There was not statistically significant difference in histologic type, histologic components, cryptorchidism, and lymphovascular invasion between the 2 groups (p=0.151, p=0.11, p=0.233, p=0.413, and p=0.14, respectively). The prevalence of ITGCN was significantly higher in patients with stage T2 and T3 of tumor than those with stage T1. Elevated serum alpha feto protein level is much common in patients with ITGCN (p<0.001). Conclusions The prevalence of concurrent ITGCN in our region is lower than previous data from western countries. ITGCN is more common in higher tumor stages and is accompanied with elevated serum alpha feto protein levels before surgery. Presence of ITGCN in adjacent tissue may suggest a negative cancer behavior.
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Testicular Germ Cell Tumours (TGCT) affect 1 in 400 men in the UK. Two per cent of TGCT cases report another affected family member. The familial relative risk is estimated to be 8–10 fold for brothers of cases and 4–6 fold for fathers and sons. This familial relative risk is considerably higher than for most common cancers suggesting that the contribution of genetic factors to TGCT may be relatively more important than for other cancers. However, the search by genetic linkage analysis for familial TGCT susceptibility genes has been confounded by the limited number of large multiple case families. The International Testicular Cancer Linkage Consortium family set currently consists of more than 190 families with at least two cases of TGCT. A genome-wide search conducted on 100 families has yielded strong evidence for a TGCT susceptibility gene on the X chromosome. This gene appears to predispose to bilateral TGCT and also possibly to undescended testis. This is the first familial TGCT gene to be localised and the first cancer susceptibility gene mapped in a genome wide search using predominantly sib pairs.
Article
Background: Testicular cancer is the commonest malignancy in young men. Improvements in survival rates have led to campaigns to raise awareness in at-risk men. We assessed the changing size of testicular tumours given the public health initiatives promoting testicular self-examination (TSE). Methods: Retrospective analysis of men (≥16 years) undergoing orchidectomy for testicular cancer at our institution over two time periods (1975-85 and 2007-12) were identified using our cancer registry. Histopathology reports were used to record testicular tumour size as the maximum measured dimension. Significance was indicated by P < 0.05. Results: Of 305 orchidectomies performed, 215 had histopathology reports available. Median age was 34 years (16-75 years). Mean tumour size was 7.2 cm in 1975-85 and 4.1 cm in 2007-12 showing a significant reduction (P = 0.02). Significant reduction was seen in all age groups except >60 years. Furthermore there was a significant increase in proportion of men presenting in the youngest age group (16-29 years) in the 2007-12 cohort (43 versus 29%, P = 0.02). Conclusion: The trend in reduction of tumour size at presentation and increased proportion of younger men presenting with testicular cancer supports an increased awareness. Promotion of TSE and public education should remain important initiatives given the increasing incidence of testicular cancer. Awareness still needs addressing in older men.
Article
Background. Many studies (hut not all) have shown that for men with testicular cancer a longer treatment delay is associated with additional treatments, greater morbidity, and shorter survival. Aim: This paper explores patients' perspectives on why treatment delays occur. Design: Qualitative study using narrative interviews Setting. Interviews in patient's homes throughout the United Kingdom (UK). Method. Interviews with a maximum variation sample of 45 men with testicular cancer, recruited through general practitioners (GPs), urologists, support groups, and charities. Results. Those who sought help relatively quickly responded to symptoms, had heard about testicular cancer in the media, had seen leaflets in GPs' surgeries, or knew others with this disease. Men delayed because they did not recognise signs and symptoms, feared appearing weak, a hypochondriac, or lacking in masculinity; recalled past illness or painful examinations,. were embarrassed, feared the consequences of treatment; or lacked time to consult their doctors. Beliefs about symptoms and pessimistic associations with cancer also led to delay Treatment delays also resulted from misdiagnosis or waiting lists. Conclusion: Whether or not men should be taught to examine themselves routinely to check for testicular cancer is much debated. This study suggests that it is important that men are aware of the normal shape and feel of their testicles, and may benefit from information about signs and symptoms of testicular cancer and the excellent cure rate. Information, provided in surgeries where men feel welcome, might encourage men to seek help promptly when a problem arises. our study also suggests that GPs may need to accept a low threshold for ultrasound investigation of testicular symptoms and that the ultrasound service needs to be improved. These measures may further reduce mortality and morbidity.
Article
Bilateral germ cell tumors of the testis are rare. A 36-year-old male had a history of left testicular embryonal carcinoma (pT1N1M0 stage II A) treated with left high orchiectomy and adjuvant chemotherapy (3 courses of PEB) 6years previously. He presented at our clinic complaining of a mass in right sided testis, and underwent orchiectomy. Histopathological examination revealed pure seminoma (pT1N0M0 Stage I A). Six months after the surgery, he is doing well without evidence of recurrence. Patients with unilateral testicular tumor have an increased risk of developing a contralateral testicular tumor. Patients are at risk for a second tumor 10 years or more after diagnosis. So we conclude that long-term monitoring of contralateral the testicle is necessary. Most contralateral testicular tumors are detected by self-examination of the remaining testis. Consequently patients should be counseled on the necessity of testicular self-examination.
Article
Testicular cancer is the most common cancer in men aged 15 to 40 years in the United States, Canada, and many European countries. Given the excellent prognosis of most men with testicular cancer, updates in care after treatment have become very important. This article provides a review of the available evidence, integrated with expert medical judgment, in the area of testicular cancer follow-up. Copyright © 2015 by the National Comprehensive Cancer Network.
Article
Purpose and intended audience: Each year, the Canadian Cancer Statistics publication provides an estimate of expected case counts and rates for common cancer sites for the current year in Canada as a whole and in the provinces and territories. This monograph expands on the Canadian Cancer Statistics publication by providing historical and projected cancer incidence frequencies and rates at national and regional levels from 1983 to 2032. The aim is that this monograph will be an important resource for health researchers and planners. Most importantly, it is hoped the monograph will: - provide evidence-based input for the development of public health policy priorities at the regional and national levels; and - guide public health officials in planning strategy including designing and evaluating preventive interventions and planning resources (treatment requirements) and infrastructure for future cancer control and care intended to reduce the burden of cancer in Canada.
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Objectives: To review and update the epidemiological aspects, risk factors (mainly genetic and immunohistochemical aspects), diagnosis and treatment of the seminoma. Material and Methods: A literature review has been carried out, using the keyword «seminoma» and the subheadings «diagnosis», «epidemiology», «etiology», «genetics», «mortality» and «treatment» without restrictions on types of study, selecting those articles considered of interest for a review. Information has been completed with other bibliographic references as clinical guidelines, cancer registries and Oncology and Urology texts. The search was limited to articles in English and Spanish. The Surveillance, Epidemiology and End Results Program (SEER) has also been used to obtain data on cancer incidence and mortality in the US, while GLOBOCAN was utilized to obtain data on other 184 countries. Results: A total of 3131 articles have been reviewed, covering a search period from the 1st January 1990 to 31st March 2012. The search included 51 reviews on tumor epidemiology, 23 on genetic risk factors, 66 reviews on different aspects of diagnosis and treatment, a prospective study and three randomized studies, including as well the guidelines of 3 Clinical Guides. Conclusions: The germ cell tumor of the testicle (TCGT) is the most common solid tumor in males between the ages of 20 and 34, and the seminoma represents 40-50% of all of them. The risk factors are multiple, congenital and acquired, in particular familial predisposition and bilaterality, cryptorchidia and some chemical carcinogenic agents considered as endocrine disruptors that might favor the development of these tumors. The increase of testicular volume and the palpation of a hard nodule, painful or not, and of variable size is the most common initial symptom. In the diagnosis the testicular sonography and tumor markers AFP and β-hCG play an important role. These tumor markers are oncofetal substances which are besides very useful in the grading and the monitoring of the response to the treatment. Currently three grading systems of these tumors are available and their joint utilization allow adapting the treatment to the risk reaching survival rates over 98% in 5 years. The first choice treatment of the seminoma in the stadium I is radical orchiectomy although there are some discrepancies about adjuvant treatment. Currently three options are considered: surveillance, chemotherapy with platinum derivatives and radiotherapy. For stadiums II and III the options after radical surgery are radiotherapy with or without chemotherapy.
Article
Paula Lowson looks at the importance of raising men's awareness of testicular cancer and testicular selfexamination and considers the practice nurse's role
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Objective: To study the clinical features of the patients with germ cell tumor of testis in the Autonomous Community of Madrid, emphasizing on the different treatments used. Material and method: Retrospective analysis of 536 patients with testicular cancer who were obtained from the Community of Madrid cancer registry, during a follow-up period of 15 years (1991-2010). Data analysis has been performed using SPSS 15.0 for Windows. Chi-square test has been used to determine possible relationships among variables. The level of significance was p ≤ 0.05 RESULTS: An increase in the incidence rate has been detected along study period. Mean age was 33.6±13.6 years. 89.7% of cases were germ cells tumors (46% seminoma and 43.6% nonseminomatous germ cell tumor [NSGCT]) and other histologic subtypes the remaining 10.3% of cases. 74% of patients were diagnosed with stage I disease, 8.2% with stage II and 16.2% with stage III; 54.3% of patients were treated with surgery plus adjuvant chemotherapy and in 5.6% of patients the treatment was surgery plus adjuvant radiotherapy. Surgery alone was used in 27.4% of cases: in 32.7% of stage I tumors, 13.6% of stage II and 9.2% of stage III. Radiotherapy was prescribed in 10% of stage I tumors, in 9% of stage II and in 3.4% of stage III. For the seminomas: the surgery-chemotherapy association was used in 49.8 of cases, surgery alone in 30% and surgery plus radiotherapy in 16.6% of cases. For the NSGCT, surgery plus chemotherapy was used in 70.5% of patients, surgery alone in 23.5% and surgery-radiotherapy association in 0.8% of cases. Conclusion: Testicular cancer incidence is increasing. Adjuvant chemotherapy is the treatment used most frequently in the more advanced stages of both seminomas and NSGCT. The tendency to reduce the use of radiotherapy in the treatment of seminoma was confirmed.
Article
Objective To study the clinical features of the patients with germ cell tumor of testis in the Autonomous Community of Madrid, emphasizing on the different treatments used. Material and method Retrospective analysis of 536 patients with testicular cancer who were obtained from the Community of Madrid cancer registry, during a follow-up period of 15 years (1991-2010). Data analysis has been performed using SPSS 15.0 for Windows. Chi-square test has been used to determine possible relationships among variables. The level of significance was p ≤ 0.05 Results An increase in the incidence rate has been detected along study period. Mean age was 33.6 ± 13.6 years. 89.7% of cases were germ cells tumors (46% seminoma and 43.6% nonseminomatous germ cell tumor [NSGCT]) and other histologic subtypes the remaining 10.3% of cases. 74% of patients were diagnosed with stage I disease, 8.2% with stage II and 16.2% with stage III; 54.3% of patients were treated with surgery plus adjuvant chemotherapy and in 5.6% of patients the treatment was surgery plus adjuvant radiotherapy. Surgery alone was used in 27.4% of cases: in 32.7% of stage I tumors, 13.6% of stage II and 9.2% of stage III. Radiotherapy was prescribed in 10% of stage I tumors, in 9% of stage II and in 3.4% of stage III. For the seminomas: the surgery-chemotherapy association was used in 49.8 of cases, surgery alone in 30% and surgery plus radiotherapy in 16.6% of cases. For the NSGCT, surgery plus chemotherapy was used in 70.5% of patients, surgery alone in 23.5% and surgery-radiotherapy asociation in 0.8% of cases. Conclusion Testicular cancer incidence is increasing. Adjuvant chemotherapy is the treatment used most frequently in the more advanced stages of both seminomas and NSGCT. The tendency to reduce the use of radiotherapy in the treatment of seminoma was confirmed.
Article
Le cancer du testicule est la tumeur la plus fréquente de l’homme jeune. L’incidence du cancer du testicule est en augmentation depuis l’après-guerre dans la quasi-totalité des pays européens. En Europe, il existe un gradient Ouest-Est dans la région de la mer baltique, et un gradient Nord-Sud en Europe occidentale. Le taux d’incidence a doublé dans plusieurs pays, dont la France depuis 1970. L’augmentation de l’incidence affecte particulièrement la classe d’âge des adolescents et des hommes jeunes. Les raisons d’une telle augmentation restent incertaines, bien que de forts soupçons pèsent sur des facteurs environnementaux (perturbateurs endocriniens), qui pourraient également retentir sur la fertilité masculine et expliquer l’augmentation des anomalies de l’appareil génital mâle.
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The 1991 census for England and Wales provides a substantial amount of data on demography, ethnicity, housing tenure, employment status, and other social factors for geographical areas ranging in size from enumeration districts upwards. Many in the health service and in the academic community are making use of the data in the 1991 census. However, users of census data need to be aware of the problems and limitations of these data, which include the format of the data, data modification and suppression, sampling error, and underenumeration. An important innovation of the 1991 census was that the census form included a question on the postcode of respondents; this allowed the Office of Population Censuses and Surveys to produce a postcode-enumeration district look up table which overcomes many of the problems previously encountered in trying to assign postcodes to enumeration districts. The new look up table also includes the grid reference of postcodes, and this will improve the geographical referencing of census data.
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Article
There are two main histological groups of testicular germ cell tumours, which may have different risk factors. Some authors have analysed potential risk factors by histological group but few consistent differences have been identified. In this paper we examine risk factors for pure seminoma and other tumours using data from the United Kingdom case control study of testicular cancer. Seven hundred and ninety-four cases were included in the study, each with a matched control; 400 cases had pure seminoma tumours, and 394 had other testicular tumours. The risk of seminoma associated with undescended testis was slightly higher than that for other tumours (odds ratio of 5.3 compared with 3.0). When split at the median age at diagnosis, this difference was greater in men aged 32 and over (odds ratio of 11.9 compared with 5.1) than in the younger men (3.0 compared with 2.5). Risks associated with testicular or groin injuries were higher in the non-seminoma group, as was the risk for a history of sexually transmitted disease. The protective effect of a late puberty was more marked for tumours of other histologies. Some differences were also detected for participation in sports. Whilst some of the differences detected may have arisen by chance, the stronger association between undescended testis and pure seminoma has been identified by a number of other studies and may reflect a genuine difference in aetiology.
Article
Collecting cancer statistics is a dry business. Much effort, dedication, and skill have been put into developing an effective network of cancer registries around Europe. Further work to standardise the datasets and provide efficient quality control now makes the comparison of cancer survival between European countries realistic. Britain does not do well in such a comparison.1The clearest outcome indicator for the quality of cancer care is the percentage of patients surviving five years after diagnosis. Most patients can be considered cured after this time, having actuarial survival curves exactly parallel to people of similar age and sex without cancer.2 The current analysis comes from 33 cancer registries in 17 countries. The figures cover the period 1978-89 and represent the most recent available, to allow for a five year maturation period and for the subsequent collection, analysis, and quality control. Because data come from cancer registries, they do not always cover the entire populations of all the participating countries. Within the United Kingdom data were available for the whole of Scotland and for almost half (46%) …
Article
Diaminodichloroplatinum was studied in a Phase I trial. Two dose schedules were explored. In Schedule I, a maximum dose of 100 mg/M2 given once was reached, and this proved too toxic for further use. The maximum dose in Schedule II, 24 mg/M2 daily for 5 days, was also too toxic, so 20 mg/M2 per day for 5 days was the dose selected for further exploration. Responses were seen in 1 patient with anaplastic thyroid carcinoma, 1 with transitional cell carcinoma of the bladder, and 1 with breast cancer. In patients with testicular tumors, responses were seen in 9 of 11 patients. There were 3 complete regressions seen, 1 in seminoma, 1 in embryonal cell carcinoma, and 1 in male choriocarcinoma. Three partial regressions, and three cases of objective improvement were also seen in this series. These were also distributed over different tumor types. The possibility that diaminodichloroplatinum has a specific effect on tissues arising from the genitourinary anlage is suggested.
Article
Twenty-three patients with stage III germinal neoplasia of the testis were treated with a variation of our original vinblastine-bleomycin program. This modification consisted of 0.4 mg/kg of vinblastine given in two fractions on Days 1 and 2 followed by continuous intravenous administration of 30 units of bleomycin in 1000 cc of 5% glucose and distilled water over a 24-hour period for 5 successive days beginning on Day 2. Therapy was repeated every 28-35 days as toxicity permitted. There were 17 responses, nine of which were complete (39%). Eight of the complete responses were in patients with massive disease in whom a low complete response rate was expected. Toxic effects consisted of severe leukopenia in 90% thrombopenia in 50%, and unexplained transient hyperbilirubinemia in about 30% of the patients. Bleomycin pneumonitis occurred in one patient and resulted in death. Hypertension was a new and unexpected side reaction experienced by four patients. Further trials are indicated since the complete response rate in patients with advanced massive disease appears to be improved.
Article
Fifty patients with disseminated testicular cancer were treated with a three-drug combination consisting of cis-diamminedichloroplatinum, vinblastine, and bleomycin. Three patients were considered inevaluable due to early death. This chemotherapy regimen produced 74% complete and 26% partial remissions. Furthermore, five patients with partial remission became disease-free after surgical removal of residual disease, producing an overall 85% disease-free status. Toxicity, although significant during remission induction with cis-platinum, vinblastine, and bleomycin, was usually manageable, although there were two drug-related deaths during this period. Thirty-eight of these patients remain alive and 32 remain alive and disease-free at 6 + to 30 + months. We believe this regimen represents a major advance in the management of patients with disseminated testicular cancer.
Article
Combination chemotherapy with cis-dichlorodiammineplatinum(II) (cis-platinum) has been used at Indiana University since August 1974. cis-Platinum (20 mg/m2 x 5 days every 3 weeks for three to four courses), vinblastine (0.4 mg/kg every 3 weeks for four courses), and bleomycin (30 units weekly for 12 weeks) were utilized as remission induction therapy until September 1976. This regimen produced 30% partial and 70% complete remission (CR) rates among 47 evaluable patients. Furthermore, an additional five patients (11%) were rendered disease-free following surgical removal of residual disease. Thirty-two (68%) of these patients remain alive, and 28 (60%) remain alive and disease-free. Twenty-six of these 28 patients have now been continuously disease-free for 2+ to 4+ years and are receiving no chemotherapy. From September 1976 to June 1978, an additional 79 patients were included in a three-arm randomized prospective study with cis-platinum, vinblastine, and bleomycin with or without Adriamycin, using different doses of vinblastine. Fifty-three patients (67%) achieved CR; an additional ten patients (13%) were rendered disease-free with surgical removal of residual localized disease. Only seven of these 63 patients (11%) have relapsed. One patient died due to a pulmonary embolus 3 months after surgical resection for residual embryonal carcinoma. Thus, 55 patients (70%) remain disease-free. Sixty-seven (85%) of these patients remain alive. Thus far, there has been no significant difference in CR rate or survival in any of the three arms. cis-Platinum, vinblastine, and bleomycin combination chemotherapy regimens consistently produce a 60%-70% CR rate; 10%-15% of the patients will be rendered disease-free following surgical removal of localized residual disease after significant chemotherapy-induced partial remission. The relapse rate remains low (10%-20%). We feel this represents a major advance in the management of disseminated testicular cancer.
Article
The records of 154 patients with non-seminomatous germ cell testicular tumours were reviewed to determine the potential effect of prompt diagnosis and orchiectomy on morbidity and mortality from this disease. Orchiectomy was performed 30 days or less after the onset of testicular symptoms on 65 patients (Group 1) and more than 30 days after the onset of symptoms on 89 patients (Group 2). The initial clinical stages of Group 1 patients were: I, 40 (62%); II, 14 (22%); III, 5 (8%); marker only, 6 (9%). The initial clinical stages for Group 2 patients were: I, 25 (28%); II, 15 (17%); III, 35 (39%); marker only, 14 (16%). The difference between the percentages of Group 1 and Group 2 patients with stage I disease was statistically significant, as was the difference between the percentages of Group 1 and Group 2 patients with stage III disease. One of the Group 1 patients died, whereas 11 of the Group 2 patients died. In 5 of the Group 2 patients who died, orchiectomy had been performed more than 120 days after the onset of testicular symptoms. This study suggests that orchiectomy performed promptly after the onset of testicular symptoms not only helps to reduce mortality from testicular cancer but also has a major effect on its morbidity by reducing the need for systemic chemotherapy or major surgery.
Article
Seventy-eight patients with disseminated testicular cancer were entered on a random prospective study evaluating three separate remission induction arms. Therapy with cis-diamminedichloroplatinum (20 mg/M2 for five consecutive days every three weeks for 3-4 courses) and bleomycin (30 units intravenous push weekly for 12 consecutive weeks) was constant. Patients were allocated at random to one of the following induction regimens (in combination with platinum plus bleomycin): (1) vinblastine 0.4 mg/kg every three weeks for four courses; (2) vinblastine 0.3 mg/kg every three weeks for four courses; or (3) vinblastine 0.2 mg/kg plus Adriamycin 50 mg/M2 every three weeks for four courses. All patients received maintenance therapy with vinblastine 0.3 mg/kg once a month for 20 months (total therapy two years) unless progressive disease intervened. The incidence of granulocytopenic fever and sepsis was highest with regimen 1, as 9 patients (35%) developed granulocytopenic fever requiring hospitalization and antibiotics; only 4 (15%) patients on regimen 2 developed granulocytopenic fever. No patients on regimen 2 had documented sepsis. Fifty-three patients (68%) achieved complete remission and an additional 11 patients were rendered free of disease with surgical resection of residual localized disease. Fifty-three patients (68%) remain alive and continuously free of disease from 15+ to 39+ months. There was no difference in the complete remission rate or disease-free status with the higher dosage of vinblastine (regimen 1) during remission induction therapy compared to the less toxic lower dosage of vinblastine (regimen 2). This suggests that dosage reduction of vinblastine to 0.3 mg/kg can produce equivalent therapeutic results with diminished toxicity, and we no longer recommend the 0.4 mg/kg vinblastine dosage.
Article
Testicular cancers were studied in patients on immunosuppression. A retrospective analysis was done of testicular cancer in patients on immunosuppression reported on between 1975 and 1995. The management schemes adopted in the immunosuppressed population followed the generally accepted management concepts. No patient with low stage (A to B1) disease died of testis cancer. Only 4 of 66 patients (6.1%) with the acquired immunodeficiency syndrome died of testis cancer compared to 5 of 20 (25%) after transplantation, implying significantly higher cause specific mortality in post-transplant patients (Fisher's exact test, p < 0.01). The incidence of adverse effect of therapy did not differ from the expected incidence in other patients. Patients on immunosuppression with testicular neoplasms should be treated in the standard fashion as indicated by tumor histology and stage of disease, since most will tolerate therapy and benefit from the standard treatment protocols.
Article
This article has no abstract; the first 100 words appear below. Approximately 95 percent of malignant tumors arising in the testis are germ-cell tumors, a term that indicates their origin in primordial germ cells. Germ-cell tumors also occasionally arise in extragonadal primary sites, and their management follows that of testicular germ-cell tumors. More than 90 percent of patients with newly diagnosed germ-cell tumors are cured, and delay in diagnosis correlates with a higher stage at presentation for treatment.¹,² Management has changed substantially in the past 20 years, largely because of the ability of cisplatin-containing combination chemotherapy to cure advanced disease.³ In this review, we discuss recent developments in our understanding . . . We are indebted to Carol Pearce for her review of the manuscript. Source Information From the Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and the Department of Medicine, Cornell University Medical College, New York. Address reprint requests to Dr. Bosl at Memorial Hospital, 1275 York Ave., New York, NY 10021.
Article
Although the concept that transplacentally acting estrogen-mimicking chemicals damage fetal germ cells is still the most favored hypothesis to explain the link between declining sperm counts and rising testis cancer, there has been increasing recognition that other mechanisms may be contributing. With reports confirming the association between a sedentary lifestyle and rising incidence of testis cancer and a fourfold increased relative risk of delay in conception of more than 3 months found for those driving a vehicle for more than 3 hours a day, there is increasing recognition that heat may be one of the most important cofactors. The role of p53 in heat-mediated damage and deficiency of heat shock protein response of germ cells and germ cell cancer are providing increasing interest in the search for molecular mechanisms to explain the unique chemosensitivity of this group of tumors. Perhaps the most controversial report was the finding of mutations insufficient to block apoptosis in 67% of tumor p53 genes using a RNA-SSCP analysis, when only a quarter of them had mutations identified by conventional DNA sequencing. The acceptance that immunosuppression, whether HIV- or chemically induced, increases risk of germ cell cancer by 20 to 50 times that in the general population is perhaps the most important final confirmation of the immune-surveillance hypothesis, although there is no evidence as yet that it seriously worsens the chance of long-term cure in these patients. Further progress is being reported on the use of high-dose chemotherapy and stem-cell transplants, although the risks of treatment-related mortality still restrict its use to second line treatment. The problem of patient consent to the increasing range of options for early-stage disease is something highlighted from reports over the past year that will undoubtedly be an important issue in the future.
Article
Women consult their GP more often than men do. The distribution of complaints and diagnoses are different for women and men patients. Although several findings on gender differentials on mortality and health care consumption are rather consistent across studies, detailed findings and subsequent conclusions diverge in several important fields. Our aim was to explore methodological aspects of research on gender differences in general practice. We reviewed empirical studies within this field, aiming to identify methodological and interpretative intricacies which deserve special attention in epidemiological research on GP consultations. We found that descriptive and explanatory levels of research are frequently confused. Simple questions, answers and explanations are commonly raised for complex issues within a poorly defined theoretical explanatory framework. There is a need to assess relevant approaches for various purposes, and to develop more uniform conceptual terms. Findings from one level are often transferred to another, incompatible level. Epidemiological issues must be considered, especially matters related to denominator level and standardization/confounders-not in order to decide which level represents 'reality', but to clarify the consequences of different measures for different research questions. The contents of the core variables and the potentials for bias should be discussed in order to provide a sound basis for future explanatory studies.
Article
This introduction provides a general overview of the aims, methods and procedures used in the EUROCARE II study and the types of analyses presented in each article of this Special Issue of the European Journal of Cancer. The main aims of the EUROCARE II project are the updating of the survival database of the European Cancer Registries, the study of recent trends in relative survival rates and the interpretation of the survival differences observed both in time and across populations. Once having completed the preliminary stage of data checking, a total of 3,473,659 individual records from patients of all cancer sites, diagnosed between 1978 and 1989 and provided by 45 cancer registries in 17 European countries were accepted to build up the EUROCARE database. The quality of these data, in terms of the accuracy of the diagnosis and the validity of vital status assessment, was checked by indirect indicators, based on cross-validation analysis of consistency of the relevant variables. Statistical analysis was based on age-specific relative survival rates, computed for each cancer sites as the ratio of observed survival to the expected survival of the general population of the same area, gender and age, according to the Hakulinen method. An estimate of the European survival was computed as a weighted mean of the corresponding survival of the different countries, using as weights the expected yearly number of incident cases in each country. For comparison purposes, age-standardised survival was also calculated for Europe and for each country involved in the study.
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The aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility and exercise
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Malignant testicular neoplasms in immunosuppressed patients
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Diaminodichloroplatinum: a phase I study showing responses in testicular neoplasia
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