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Cancer Trends No 15. Cancer of the testis
August 2012
Figure 2. Testicular cancer as a percentage of all cancers
diagnosed in patients of different age groups, 1994-2010
100%
Cancer
Trends
percent of all invasive cancers
80%
Cancers of the testis
60%
other cancers
testis
40%
Case numbers and histological types
20%
Table 1. Annual average number of testicular cancers diagnosed
in Ireland and percentage of histological types, 1994–2010
cases per year
incidence rate (cases per 100,000 per year)
histological subtype
non-seminomatous germ cell
seminoma
spermatocytic seminoma
sarcoma
sex-cord tumours
other/unspecified
40.4%
57.0%
0.6%
0.9%
0.4%
0.7%
Age profile
Testicular cancers are more common in young men; three-quarters of
all patients in Ireland were under 40 years at diagnosis (Figure 1). The
highest incidence rates were in patients aged between 25 and 34.
<25
25-39
40-49
50+
The sub-type of testicular cancer also varies with age (Figure 3).
Non-seminomatous tumours were most common in younger
patients and made up 80% of testicular tumours in patients under
20 years of age. A decline in the proportion of non-seminomatous
tumours, with an accompanying increase in the proportion of
seminomas, was apparent with increasing age. Over 80% of
tumours diagnosed in patients aged 40 or over were
seminomatous cell types.
Figure 3. Variation in the proportion of seminomatous and nonseminomatous testicular cancer subtypes by age group, 19942010
35
30
25
20
15
10
5
0
<20
Figure 1. Number of cases and age specific rate of testicular
cancer by 5 year age group, 1994-2010
30
20-29
30-39
non-seminomatous
40-49
50+
seminoma
20.0
16.0
14.0
20
12.0
15
10.0
8.0
10
6.0
4.0
5
rate (cases per 100,000 per year)
18.0
25
number of cases per year
2.0
cases
Time trends in incidence and mortality
There has been a clear increase in case numbers and incidence
rates per year for testicular cancer in Ireland since 1994. The
overall annual percentage increase in age-standardised rate was
2.1% (±1.5%) between 1994 and 2010 (Figure 4). Similar trends
have been reported internationally, and worldwide incidence rates
have more than doubled in the past 40 years.2 3
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
5-9
0.0
10-14
0
0-4
rate
Figure 4. Trends in testicular cancer incidence, 1994–2010
250
10.0
200
7.0
150
6.0
5.0
100
4.0
3.0
50
2.0
1.0
cases
More information on cancer is available on our website www.ncri.ie
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
0.0
1995
0
1994
Testicular cancer is relatively rare compared to other cancer sites and
overall makes up less than 2% of all invasive cancers diagnosed in
men.1 However in young patients, it is one of the most common
cancers, representing 30% of all cancers in 25-39 year olds (Figure 2).
Very few men aged over 50 are diagnosed with testicular cancer (less
than 10 per year).
8.0
incidence rate
© National Cancer Registry 2012.
rate (cases per 100,000 per year)
9.0
number of cases
1
132
6.2
0%
number of cases per year
An average of 132 cases of testicular cancer was diagnosed per year
in Ireland between 1994 and 2010 (Table 1). Almost all cases were
microscopically verified (98%) and were germ-cell tumours—57% of
which were seminomatous and 40% non-seminomatous subtypes.
Non germ-cell subtypes, of which less than 2 cases were diagnosed
per year, included sarcomas and sex cord tumours.
Cancer Trends No 15. Cancer of the testis
Despite the increase in incidence, mortality rates for testicular
cancer have fallen substantially in Ireland since the 1950s (Figure
5). Although mortality rates have been variable between years, a
clear decline is evident, from the maximum rates during the
1970s, when up to 20 deaths per year were registered, to recent
years when fewer than 10 people per year have died from this
cancer. Most of this decline in mortality occurred over a relatively
short period between 1981 and 1985.
Figure 5. Trends in testicular cancer mortality, 1955–20094
deaths per 100,000 per year (world age
standardised)
1.40
1.20
1.00
0.80
Stage at diagnosis
The majority of testicular cancers are diagnosed at an early stage
(stage I) - particularly seminomas, which tend to be slower growing
than non-seminomatous tumours3 (Figure 7). Overall, more than
60% of all testicular cancers were diagnosed at stage I. A slight
decline over time was observed in the proportion of stage I
tumours, with a corresponding increase in stage II tumours, where
cancer is present in the lymph nodes. However, this may be
influenced by improvements in imaging techniques over time,
allowing for more accurate staging. Although a greater proportion
of non-seminomatous cancers were late stage (stage III) compared
to seminomas, their numbers overall were small (<150 cases in
the 17 year period) and the proportion has declined over time,
from 20% in 1994-1998 to 14% in 2005-2010.
0.60
Figure 7. Percentage of testicular cancers by stage for
seminoma and non-seminomatous subtypes, 1994-2010
0.40
0.20
2009
2007
2005
2003
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
1979
1977
1975
1973
1971
1969
1967
1965
1963
1961
1959
1957
1955
0.00
Stage I
seminoma
Stage II
International variation in incidence and mortality
2
August 2012
1994-1998
The highest incidence rates of testicular cancer were recorded in
Norway and Denmark (>10 cases per 100,000 per year, world age
standardised rate) while the lowest incidence in Europe was recorded
in Spain, Portugal and Greece (<3 cases per 100,000 per year) (Figure
6). Spatial and temporal variation in testicular cancer incidence rates
in Europe has been the subject of some debate, with exposure to
environmental pollutants and genetic predisposition cited as possible
risk factors. Differences in disease awareness have also been
proposed as an explanatory factor.2 Incidence in Ireland was
approximately 20% higher than the average for the 25 countries
examined but was similar to that in the Netherlands and Germany.
Mortality rates varied less between countries, and averaged 0.3
deaths per 100,000 per year with Ireland ranking close to the average.
1999-2004
Stage III
2005-2010
unknown
0%
40% 60%
% of cases
80% 100%
Stage I
non-seminomatous
Stage II
1994-1998
Stage III
1999-2004
2005-2010
unknown
0%
Figure 6. Incidence for testicular cancer in 25 countries, 20085
Norway
Denmark
Slovenia
Switzerland
Slovakia
Luxembourg
Czech Republic
Germany
Ireland
The Netherlands
Hungary
Austria
France
Croatia
United Kingdom
Italy
Sweden
Belgium
Finland
Poland
Spain
Portugal
Greece
USA
Canada
20%
20%
40% 60%
% of cases
80% 100%
Treatment
Almost all patients diagnosed with testicular cancer undergo surgery
as their main treatment (Figure 8). Surgery normally involves the
removal of the entire testis, as recommended by international
guidelines6 and very few patients (<3% in Ireland) have a local excision
only.
The decision to administer chemotherapy or radiotherapy is
determined by both the type of tumour and the stage of the disease.6
Between 50% and 60% of all patients with seminoma received
radiotherapy in addition to surgery (Figure 8). In contrast, few patients
(<5%) with non-seminomatous tumours had radiotherapy, but were
more likely to have chemotherapy.
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
world age-standardised rate per 100,000 per year
Overall, there has been little change over time in the proportion of
patients having surgery and chemotherapy. However, there has been
a recent decline in the proportion of seminoma patients undergoing
radiotherapy.
*Note: the rates shown are world age standardised (so Irish rates appear somewhat
higher than in Figure 4 (European age standardised rates)
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2012.
Cancer Trends No 15. Cancer of the testis
August 2012
(where comparable data is available) is fairly low and Ireland is
ranked close to the European average.
Figure 8. Treatment by time period: seminomatous and nonseminomatous testicular cancer, 1994–2010
Figure 9. Five year relative survival testicular (period analysis
2000-20028)
surgery
seminoma
chemotherapy
Scotland
1994-1998
1999-2004
radiotherapy
Sweden
2005-2010*
Norway
no treatment
0%
20%
40%
60%
% of cases
80%
EUROCARE-4 mean
100%
Ireland*
surgery
England
non-seminomatous
chemotherapy
Belgium
1994-1998
1999-2004
radiotherapy
2005-2010*
Netherlands
no treatment
Switzerland
0%
20%
40%
60%
80%
100%
US SEER-13 registries
% of cases
Italy
*for radiotherapy, figures represent 2005-2009 inclusive
Finland
Poland
Survival7
3
Testicular cancer has one of the highest cure rates of all cancers,
with a 5 year relative survival overall of over 96% (Figure 8).
Patients diagnosed with seminoma had five-year survival rates of
close to 99%, which may reflect the fact that the majority of
patients are diagnosed at an early stage (stage I). Long term
prognosis for testicular cancer is very good - for those patients
diagnosed in Ireland in 1994 and 1995, the earliest years for
which national data are available, 86% are known to have survived
at least 15 years after their diagnosis.
Figure 8. Five year relative survival (with 95% confidence
intervals) for testicular cancer patients7
50
60
70
80
90
100
relative survival (%) at 5 years
*for Ireland, cases diagnosed 2000-2010 inclusive
References and notes
1. Cancer in Ireland, 2011. Annual report of the National Cancer Registry.
NCRI.
2. Huyghe,E. et al, 2007. Testicular cancer variations in space and time in
Europe. Eur Urol 51 (3): 621-628.
3. National Cancer Institute, USA. Testicular cancer screening PDQ.
www.cancer.gov/cancertopics/pdq/screening/testicular
4. Source: WHO mortality database. www-dep.iarc.fr/WHOdb/WHOdb.htm
5. Source: Globocan database. http://globocan.iarc.fr/
all testicular cancers
6. Albers, P et al, 2012. European Association of Urology - Guidelines on
testicular cancer. Actas Urol Esp. 36(3):127-45
7. Cases diagnosed 2000-2009, followed up to 31/12/2010.
8. Recent cancer survival in Europe: a 2000–02 period analysis of
EUROCARE-4 data. Verdecchia A, et al; EUROCARE-4 Working Group.
Lancet Oncol. 2007, 8:784–96.
seminoma
non-seminomatous
50%
60%
70%
80%
90%
100%
International variation in survival8
Five year relative survival of testicular cancer patients is generally
high in all developed countries and the most recent estimate for
Europe overall was 97% (Figure 9). Variation between countries
More information on cancer is available on our website www.ncri.ie
© National Cancer Registry 2012.