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Malignancies – Testicular Germ Cell Cancers

Testicular germ cell cancers

Introduction

It appears that only seminoma (as opposed to non-seminoma germ cell tumours) occurs more frequently in HIV infection. There is no clear consensus on the exact relative risk but it ranges between approximately 3 and 7. There is no evidence that the incidence is increasing in the era of HAART1. The cause for this increased incidence is unclear. Patients present with only moderate immune suppression and they appear to be about 10 years younger than their HIV-negative counterparts. Patients with HIV-related testicular cancer have a similar cancer-free outcome compared to their HIV-negative counterparts if treated in an identical manner in the HAART era.

Diagnosis should follow an identical path regardless of HIV status and all patients should be tested for HIV infection. False positive AFP can be related to HAART/hepatitis-related liver disease.

Patients should receive HAART during adjuvant or metastatic chemotherapy.



Screening and Prevention

There is inadequate evidence that screening by clinician examination or patient self-examination has a higher yield or greater accuracy for detecting testicular cancer at earlier (and more curable) stages. Based on the low incidence of this condition and favorable outcomes of treatment, even in cases of advanced disease, there is adequate evidence that the benefits of screening for testicular cancer are small to none2.

 

References

  1. British HIV Association Guidelines for HIV-associated malignancies 2013. Version 1. 25 July 2013.
  2. U.S. Preventive Services Task Force. Screening for Testicular Cancer: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004.