Adolescent and Young Adult Testicular Germ Cell Tumors: Special Considerations.

Amanda F Saltzman,Nicholas G Cost

doi:10.1155/2018/2375176

Abstract

While testicular germ cell tumors (T-GCTs) make up only 0.5% of pediatric malignancies and less than 2% of adult malignancies, they comprise 14% of adolescent malignancies, making it the most common solid tumor in this age group. The transition in incidence at this age is also accompanied by a transition in tumor histology with adolescents having mostly pure embryonal carcinoma and mixed nonseminomatous germ cell tumors. Similar to T-GCTs of all ages, surgical excision with orchiectomy is the standard initial step in treatment. Chemotherapy, retroperitoneal lymph node dissection, and targeted treatment of distant metastases make even widely disseminated disease treatable and curable. For this reason, in many ways, the future focus has expanded beyond survival alone to emphasize quality of life issues such as fertility and hypogonadism. However, adolescents remain the age group least studied or understood as they fall in between the ages included in most study designs. Also, they require the most psychosocial support because of the challenges unique to the adolescent period. In this review, we aim to highlight the known outcome data for T-GCTs in this population and also to discuss the unique aspects of treatment and support for this age group.

Highlights

In pediatric oncology, significant advances have been made in survival of a variety of malignancies. e OS of children with cancer as a group approaches 80%, largely due to the collaborative efforts of cooperative groups [1]
Numerous reports have shown that this triumph has not been evenly distributed across patients of all ages—the adolescent age group has not enjoyed the same success as younger children, and this has been demonstrated for testicular germ cell tumors (T-GCTs) [2]
Compared with older adults with testicular cancer survival patterns differ [8], there are insurance coverage issues [5], and these patients are less likely to participate in clinical trials, are more likely to experience delays in diagnosis or treatment [9], and are more likely to suffer psychosocial problems and decreased quality of life related to their diagnosis [10, 11]

Summary

Introduction

Significant advances have been made in survival of a variety of malignancies. e OS of children with cancer as a group approaches 80%, largely due to the collaborative efforts of cooperative groups [1]. Compared with older adults with testicular cancer survival patterns differ [8], there are insurance coverage issues [5], and these patients are less likely to participate in clinical trials, are more likely to experience delays in diagnosis or treatment [9], and are more likely to suffer psychosocial problems and decreased quality of life related to their diagnosis [10, 11] Because of these disparities, in 2006, the American Cancer Society and National Cancer Institute with help from the LIVESTRONG Young Adult Alliance called for future research to focus on cancer outcomes in AYA patients and established the AYA Oncology Progress Review Group [12]. Ere must be collaboration and cooperation of providers who care for children and adults and fluid transition between the two

Disease-Specific Aspects Unique to the AYA Population

III IV

Late Effects

Findings

Conclusions and Future Directions