Management of testicular tumours in patients with undescended testes – a challenging but rewarding task: experience from a tertiary care cancer centre in India

20 Mar 2023
Arnav Tongaonkar, Vijai Simha, Nandini Menon, Vanita Noronha, Ganesh Bakshi, Vedang Murthy, Santosh Menon, Nilesh Sable, Rahul Krishnatry, Palak Popat, Mahendra Pal, Gagan Prakash, Archi Agarwal, Bhagyashri Shivaji Jadhav, Kumar Prabhash, Amit Joshi

Objective: Primary objective: To study patients’ clinical profile and outcomes with germ cell tumours developing in undescended testes.

Materials and methods: Case records of patients enlisted in the prospectively maintained ‘testicular cancer database’ at our tertiary cancer care hospital from 2014 to 2019 were retrospectively reviewed. Any patient who presented with testicular germ cell tumour with a documented history/diagnosis of undescended testes, whether surgically corrected or not, was considered for this study. The patients were managed along the standard lines of treatment for testicular cancer. We evaluated clinical features, difficulties and delays in diagnosis and complexities in management. We evaluated event-free survival (EFS) and overall survival (OS) using the Kaplan–Meier Method.

Results: Fifty-four patients were identified from our database. The mean age was 32.4 years (median age 32, range: 15–56 years). Seventeen (31.4%) had developed cancer in orchidopexy testes, and 37 (68.6%) presented with testicular cancer in uncorrected cryptorchid testes. The median age at orchidopexy was 13.5 years (range: 2–32 years). The median time from symptom onset to diagnosis was 2 months (1–36 months). There was a delay in the initiation of treatment of more than 1 month in 13 patients, with the longest delay being 4 months. Two patients were initially misdiagnosed as gastrointestinal tumours. Thirty-two (59.25%) patients had seminoma, and 22 (40.7%) patients had non-seminomatous germ cell tumours (NSGCT). Nineteen patients had metastatic disease at presentation. Thirty (55.5%) patients underwent orchidectomy upfront while in 22 (40.7%) patients, orchidectomy was done after chemotherapy. The surgical approach included high inguinal orchidectomy, exploratory laparotomy or laparoscopic surgery per the clinical situation. Post-operative chemotherapy was offered as clinically indicated. At a median follow-up of 66 months (95% CI: 51–76), there were four relapses (all NSGCT) and one death. The 5-year EFS was 90.7% (95% CI: 82.9–98.7). The 5-year OS was 96.3% (95% CI: 91.2–100)

Conclusions: The tumours in undescended testes, particularly those without prior orchiopexy, often presented late and with bulky masses, requiring complex multidisciplinary management. Despite the complexity and challenges, our patient’s OS and EFS matched that of patients with tumours in normally descended testes. Orchiopexy may help in earlier detection. In the first such series from India, we show that testicular tumours in the cryptorchid are also as curable as the germ cell tumours developing in the descended testis.

A multidisciplinary disease management group with expertise in managing complex cases is crucial for a favourable outcome in these groups of patients. We also found that orchiopexy done even later in life confers an advantage in terms of early detection in a subsequently developing testicular tumour .

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