Cases Of Testicular Cancer Research Articles

Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men: Fossa SD, Chen J, Schonfeld SJ, McGlynn KA, McMaster ML, Gail MH, Travis LB, Department of Clinical Cancer Research, The Norwegian Radium Hospital, University of Oslo, Oslo, Norway

Although risk estimates for synchronous and metachronous contralateral testicular cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral testicular cancer. We evaluated the risk of contralateral testicular cancer and survival in a large population-based cohort of men diagnosed with testicular cancer before age 55 years. For 29,515 testicular cancer cases reported to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral testicular cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral testicular cancer, and the 10-year overall survival rate of both synchronous and metachronous contralateral testicular cancer, using the Kaplan-Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original cancer. A total of 175 men presented with synchronous contralateral testicular cancer; 287 men developed metachronous contralateral testicular cancer (O/E = 12.4 [95% confidence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the first testicular cancer was associated with a statistically significantly decreased risk of metachronous contralateral testicular cancer (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at first testicular cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous contralateral testicular cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral testicular cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral testicular cancer was 85% (95% CI = 78% to 90%). The low cumulative risk of metachronous contralateral testicular cancer and favorable overall survival of patients diagnosed with metachronous contralateral testicular cancer is in accordance with the current U.S. approach of not performing a biopsy on the contralateral testis.

Space-time Clustering Analyses of Testicular Cancer Amongst 15–24-year-olds in Northern England

There has been speculation that environmental exposures may be involved in the aetiology of testicular cancer in adolescent boys and young men. Indirect evidence for this hypothesis would be provided by the finding of space-time clustering. To examine this we have looked for evidence of space-time clustering using data from a population-based cancer registry from Northern England. All cases of testicular cancer diagnosed in males aged 15-24 years during the period 1968-2002 were included in the study. Tests for space-time interactions between cases were applied with fixed thresholds of close in space and close in time. Addresses at birth and diagnosis were used in the analyses. To adjust for the effect of varying population density tests were repeated replacing fixed geographical distances with nearest neighbour thresholds. A total of 257 cases of testicular cancer were identified for analysis. Overall there was no evidence for space-time clustering. However, there was statistically significant space-time clustering for 15-19-year-old based on time of birth and place of diagnosis (p<0.001). The very limited finding of space-time clustering may provide tentative evidence for an environmental, or infectious component to aetiology. However, it may well be a chance finding. A larger study based on national data is required.

Treatment of Stage I Testicular Germ-Cell Tumors

More than a half of patients with testicular cancer are diagnosed with clinical stage I disease. In this setting, definitive cure is the rule. However, there is no consensus on the optimal treatment choice. A literature review (1990-2005) was performed in order to identify the pros and the cons associated with each therapy, as well as their long-term outcomes. Several treatment alternatives yield similar efficacy results. Thus, therapy-related morbidity, economic costs, quality-of-life issues, and patient preferences should be considered. Refinement in the knowledge of predictive factors for relapse and amounting experience with both surveillance and adjuvant chemotherapy have led to consideration of risk-adapted treatment policies as an alternative to more traditional approaches (i.e., prophylactic irradiation for seminomas and retroperitoneal lymph node dissection for non-seminomas). In conclusion, with cure rates approaching 100%, close surveillance for low-risk patients and adjuvant chemotherapy for those at high risk of relapse seems the preferred option for clinical stage I testicular cancer, in both seminoma and non-seminoma cases.

INCREASED INCIDENCE OF TESTICULAR CANCER IN MEN PRESENTING WITH INFERTILITY AND ABNORMAL SEMEN ANALYSIS

We determined the standardized incidence ratio of testicular cancer in infertile men presenting with an abnormal semen analysis compared to the general population. The charts from more than 3,800 men presenting with infertility and abnormal semen analysis during a 10-year period were retrospectively reviewed. The incidence of testicular tumors diagnosed in this group was compared to that of race and age matched controls during the same period from the general population (as reported by the Surveillance, Epidemiology and End Results [SEER] database). Of 3,847 men 10 (0.3%) with infertility and abnormal semen analysis were diagnosed with testicular tumors. Mean patient age was 32.6 years (range 25 to 52) and all 10 men were diagnosed with a seminomatous germ cell tumor. Two men had a history of cryptorchidism while the remaining 8 had no identifiable risk factors for testicular cancer. The SEER database reported an incidence of 10.6 cases of testicular cancer (95% CI 10.3-10.8) per 100,000 men of similar age group and racial composition during the same period. The standardized incidence ratio of testicular cancer was 22.9 (95% CI 22.4-23.5) when comparing our infertile group to the control population. Exclusion from analysis of the 2 patients with a history of cryptorchidism decreased the standardized incidence ratio to 18.3 (95% CI 18.0-18.8). Infertile men with abnormal semen analyses have a 20-fold greater incidence of testicular cancer compared to the general population. Patients and physicians should be aware that one of the causes of infertility could be cancer, particularly testicular cancer.

Consultation with the Specialist: Testicular Masses/Cancer

1. William P. Adelman, MD* 2. Alain Joffe, MD, MPH† 1. *Head, Department of Adolescent Medicine, National Naval Medical Center; Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md 2. †Director, Student Health and Wellness Center, Johns Hopkins University; Associate Professor of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md After completing this article, readers should be able to: 1. Describe the presentation, epidemiology, clinical aspects, management, and preventive measures associated with testicular tumors in adolescents. 2. Discuss the differential diagnosis of scrotal masses in the adolescent. A 19-year-old college sophomore presents to the University Health Service with a complaint of a “painful left testicle.” He noted gradually worsening testicular pain over the past 2 to 3 days. He is sexually active, with his last encounter occurring 8 weeks prior to the visit. He denies dysuria, penile discharge, back pain, flank pain, fever, chills, or sweats. He denies recent trauma or any history of testicular problems. The family and social history are noncontributory. On physical examination, he has no gynecomastia, and findings on his lung and heart examinations are normal. He is sexually mature (Sexual Maturity Rating 5) and is circumcised. He has no skin lesions or appreciable lymphadenopathy. The contents of his right scrotum are normal; his left epididymis is palpable and nontender; his left spermatic cord is without visual or palpable varicosity; and his left testicle is palpable and normal in size, lie, and shape, but is markedly tender to palpation at the inferior pole. It does not transilluminate. Pain does not decrease with elevation of the testis. Ultrasonography reveals a testicular tumor at the lower pole, with bleeding into the tumor. Following appropriate staging evaluation, he undergoes orchiectomy followed by radiation and chemotherapy and recovers fully. ### Tumor of the Testis Testicular cancer, predominantly of germ cell origin (95%), is the most common cancer of young men between 15 and 34 years of age, accounts for 3% of all cancer deaths in that age group, and may affect as many as 1 in 10,000 teens. It is projected that in 2005, 8,010 new cases of testicular cancer will be diagnosed, and 390 men will …

Testicular cancer patterns in Asian-American males: An opportunity for public health education to impact outcomes

Objectives To examine the racial differences in testicular cancer incidence, pathologic grade, stage, and survival with specific reference to Asian and white Americans and to evaluate the impact of disparities in stage at presentation, if present, on survival. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted all testicular cancer cases among white and Asian-American males for the years 1973 to 2000. Baseline demographic data included age at diagnosis, year of diagnosis, stage at diagnosis, and histologic features. Survival was examined using the Kaplan-Meier method and Cox proportional hazards modeling. Results The incidence of testicular cancer is lower among Asian Americans than among whites. However, Asian-American males presented with higher stage disease at diagnosis. Significant differences were noted in the histologic features between the two groups, with Asian Americans presenting with greater rates of seminoma. Asians also demonstrated survival differences, with poorer unadjusted survival compared with whites. However, when the variables of stage at diagnosis and histologic features were included in the analysis, the survival curves became similar. Conclusions Asians appeared to present with higher stage disease than do whites. Observed differences in survival for the Asian group relative to whites appeared to be primarily a result of delayed presentation. Cultural perceptions of malignancy and the understanding of cancer screening may be important determinants of later presentation. Healthcare access and education issues, rather than inherent biologic differences, are more likely the primary underlying factors for the observed survival differences in Asian males.

Testicular cancer patterns in African-American men

Objectives To compare the testicular cancer incidence, pathologic grade, stage, and survival between African Americans and whites. African Americans had a worse outcome relative to whites with regard to a number of different malignancies. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted all testicular cancer cases among white and African-American males for 1985 to 2000. Baseline demographic data included age at diagnosis, year of diagnosis, stage at diagnosis, and histologic type. Survival was examined using the Kaplan-Meier method and Cox proportional hazards modeling. Results The incidence of testicular cancer among African Americans was one fourth that observed among whites. However, African-Americans presented with a higher disease stage at diagnosis. African Americans also presented with significantly lower proportions of embryonal cell carcinoma. Overall survival among African-Americans was significantly worse at both 5 and 10 years. When overall survival was adjusted for stage at presentation and histologic type, the observed survival differences disappeared. Conclusions African Americans appear to present with a higher disease stage than do whites. Observed differences in survival for the African-American group relative to whites appear to be primarily due to delayed presentation. Cultural perceptions of malignancy and understanding of cancer screening may be an important determinant of later presentation. Healthcare access and education issues, rather than inherent biologic differences, appear to be the primary underlying factor for the observed survival differences in African-American males.

Subfertility and the risk of testicular germ cell tumors (United States)

Previous studies have reported an association between subfertility and the risk of testicular germ cell tumors. We examined fertility, measured by number of children fathered and prior diagnosis of infertility, as a risk factor for testicular cancer, while accounting for the influence of occult cancer and cryptorchidism. Tumor registry data were used to identify 329 cases of testicular cancer in white men aged 20 to 69 years, diagnosed in western Washington State from 1977 to 1983; 672 cancer-free controls were identified by random-digit dialing. Telephone interviews ascertained reproductive histories and basic demographic information. Logistic regression was used to estimate the relative risk of testicular cancer associated with fertility. Testicular cancer risk was decreased among men who had previously fathered a child (age-adjusted odds ratio (OR) 0.76, 95% confidence interval (CI): 0.54-1.06). Inverse associations were seen for seminomas and non-seminomas, and only slight attenuations in the ORs were observed when men with a history of cryptorchidism were excluded. Prior diagnosis of infertility was associated with an increased risk of testicular cancer (OR 2.40, 95% CI: 1.00-5.77). These results are consistent with an increased risk of testicular cancer among men with reduced fertility that goes beyond the effects of cryptorchidism.

Risk of Contralateral Testicular Cancer: A Population-based Study of 29 515 U.S. Men

Although risk estimates for synchronous and metachronous contralateral testicular cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral testicular cancer. We evaluated the risk of contralateral testicular cancer and survival in a large population-based cohort of men diagnosed with testicular cancer before age 55 years. For 29 515 testicular cancer cases reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral testicular cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral testicular cancer, and the 10-year overall survival rate of both synchronous and metachronous contralateral testicular cancer, using the Kaplan-Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original cancer. A total of 175 men presented with synchronous contralateral testicular cancer; 287 men developed metachronous contralateral testicular cancer (O/E = 12.4 [95% confidence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the first testicular cancer was associated with a statistically significantly decreased risk of metachronous contralateral testicular cancer (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at first testicular cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous contralateral testicular cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral testicular cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral testicular cancer was 85% (95% CI = 78% to 90%). The low cumulative risk of metachronous contralateral testicular cancer and favorable overall survival of patients diagnosed with metachronous contralateral testicular cancer is in accordance with the current U.S. approach of not performing a biopsy on the contralateral testis.

Polymorphisms in RAI and in genes of nucleotide and base excision repair are not associated with risk of testicular cancer

Testicular cancer has been suggested to be primed in utero and there is familiar occurrence, particularly brothers and sons of men with testicular cancer have increased risk. Although no specific causative genotoxic agents have been identified, variations in DNA repair capacity could be associated with the risk of testicular cancer. A case–control study of 184 testicular cancer cases and 194 population-based controls living in the Copenhagen Greater Area in Denmark was performed. We found that neither polymorphisms in several DNA repair genes nor alleles of several polymorphisms in the chromosomal of region 19q13.2-3, encompassing the genes ASE, ERCC1, RAI and XPD, were associated with risk of testicular cancer in Danish patients. This is in contrast to other cancers, where we reported strong associations between polymorphisms in ERCC1, ASE and RAI and occurrence of basal cell carcinoma, breast cancer and lung. To our knowledge this is the first study of DNA repair gene polymorphisms and risk of testicular cancer.

Testicular cancer, occupation and exposure to chemical agents among Finnish men in 1971–1995

To find associations between testicular cancer, occupation and chemical exposure. A cohort of all economically active Finnish men born between 1906 and 1945 was followed-up for 19.7 million person-years during 1971-1995. Incident cases of testicular cancer (n=387) were identified in a record linkage with the Finnish Cancer Registry. The Census occupations in 1970 were converted to chemical exposures with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as the product of prevalence, level, and duration of the exposure. Standardised incidence ratio (SIR) was calculated for each of the 393 occupations, and for CE categories of the 43 chemical agents, using average male population as reference. Relative risks (RR) comparing various CE-categories with unexposed ones were defined for selected agents by Poisson regression analysis. Elevated SIRs were observed among railway traffic supervisors (5.8, 95% CI 1.6-14.7), programmers (4.3, 1.4-9.9), university teachers (4.1, 1.3-9.5) and electrical engineers (3.9, 1.1-10.1). A significant exposure-response trend (mainly contributed by seminoma) was observed for pesticides, textile dust, aliphatic and alicyclic hydrocarbons, and some other organic solvents. Risk of testicular cancer increased only in four occupations. Pesticides, textile dust, and some organic solvents may be related to an excess risk of seminoma.

Carpenters, Cabinetmakers, and Risk of Testicular Germ Cell Cancer

A recent cohort study showed an increased risk of testicular cancer among members of the United Brotherhood of Carpenters and Joiners of America. We explored our data of a German population-based case-control study on the etiology of testicular cancer with regard to this association. The case-control study included 269 testicular cancer cases and 797 controls. We applied conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). People who worked as cabinetmakers or carpenters had an OR of 0.84 (95% CI = 0.45-1.56). Risks were increased among cabinetmakers who worked at least 15 years ago (OR = 5.81, 95% CI = 1.20-28.09). Ever being employed as a carpenter was associated with a reduced OR of 0.59 (95% CI = 0.24-1.46). Cabinetmakers may be at an increased risk of testicular cancer.

Testicular Cancer Incidence in Eight Northern European Countries: Secular and Recent Trends

Abstract Objective: Striking geographic variation and marked increasing secular trends characterize the incidence of testicular cancer. However, it is not known whether these patterns have attenuated in recent years and whether they are similar for seminomas and nonseminomas, the two main histologic groups of testicular cancer. Method: Cancer registry data, including 27,030 testicular cancer cases, were obtained from Denmark, Estonia, Finland, Latvia, Lithuania, Norway, Poland, and Sweden. Between 57 (Denmark) and 9 (Poland) years of registration were covered. Country-specific temporal trends were estimated, with focus on the last decade and seminomas and nonseminomas. Data from the Nordic countries were further analyzed using an age-period-cohort approach. Results: Age-standardized incidence rates increased annually by 2.6% to 4.9% during the study period, with marginal differences between seminomas and nonseminomas. In the last decade, the increasing trend attenuated only in Denmark (annual change, −0.3%; 95% confidence interval, −1.5 to 0.9). In 1995, the highest and the lowest age-standardized incidence rates (per 105) were 15.2 in Denmark and 2.1 in Lithuania. Incidence rates (i.e., for all cancers and for seminomas and nonseminomas, separately) depended chiefly on birth cohort rather than on calendar period of diagnosis (although both birth cohort and period determined the Danish incidence rates). Conclusions: Testicular cancer incidence is still increasing, with the exception of Denmark, and a large geographic difference exists. The increasing trend is mainly a birth cohort phenomenon also in recent cohorts. Temporal trends for seminomas and nonseminomas are similar, which suggests that they share important causal factors.

The rising incidence of stage 1 seminoma; a reflection of earlier diagnosis of germ cell cancer of the testis in last 20 years

4521 Background: The last 20 years has seen a dramatic change in outcome of treating metastatic testis cancer, coinciding with a marked increase in incidence. The reasons for this increase remain unclear. In an attempt to investigate this further, this abstract reviews pathological and clinical staging in patients registered in the Anglian Germ Cell Tumour Group data base between 1983 and 2002. Methods: Clinicians from 7 treatment centres (St Bartholomew'ss, Oldchurch, Southend, Colchester, Ipswich, Norwich and Cambridge) prospectively registered cases of testicular cancer in a central data base between 1983 and . The patients were divided into 3 time periods (1983–1988, 1989–1995, 1996–2002). The relative incidence of seminoma vs non seminoma and local vs metatatic disease were compared.The size of the stage 1 tumours were assessed and recorded from 2 of the treatment centres over the time period. Results: During the time of study, stage 1 seminoma increased significantly from 34% to 44% to 52%, while me...

The rising incidence of stage 1 seminoma; a reflection of earlier diagnosis of germ cell cancer of the testis in last 20 years

4521 Background: The last 20 years has seen a dramatic change in outcome of treating metastatic testis cancer, coinciding with a marked increase in incidence. The reasons for this increase remain unclear. In an attempt to investigate this further, this abstract reviews pathological and clinical staging in patients registered in the Anglian Germ Cell Tumour Group data base between 1983 and 2002. Methods: Clinicians from 7 treatment centres (St Bartholomew'ss, Oldchurch, Southend, Colchester, Ipswich, Norwich and Cambridge) prospectively registered cases of testicular cancer in a central data base between 1983 and . The patients were divided into 3 time periods (1983–1988, 1989–1995, 1996–2002). The relative incidence of seminoma vs non seminoma and local vs metatatic disease were compared.The size of the stage 1 tumours were assessed and recorded from 2 of the treatment centres over the time period. Results: During the time of study, stage 1 seminoma increased significantly from 34% to 44% to 52%, while metastatic non seminoma decreased from 31% to 23% to 16% (p<0.05 for both). The relative incidence of metastatic seminoma and stage 1 non-seminoma remained unchanged. The mean age of the patients at the time of presentation of the tumour did not alter over the 20 year period. For patients with stage I disease, there was a reduction in the average size of the primary tumour (4.7 to 3.9 cms) during this period. Conclusions: The reduction in tumour size and the decreased frequency of patients with metastases could be a true product of increasing patient education about early diagnosis. The relative increase in the incidence of seminoma is an interesting observation and requires further investigation. These findings could be an artefact of patient referral data from selected centres, and needs validating by prospective cancer registrations, which is now in progress. No significant financial relationships to disclose.

Ethnic variation in the prevalence of AZF deletions in testicular cancer

Seventy-six percent of testicular cancers of origin in Finns have been reported to exhibit AZF deletions. We analyze here 40 testicular tumor cases from Norway and Argentina and we found that AZF deletions occur also in non-Finnish cases but at significantly lower frequency (25%) than in Finland testicular tumor cases. This frequency difference can be attributed to the condition of genetic isolate of the Finnish population and the subsequent prevalence in this ethnic group of genetic factors involved in the origin of AZF deletions associated with malignancies. The finding of a correlation between AZF deletions and a given Y haplogroup would indicate the existence of Y lineages carrying AZF deletion-enhancing gene or genes. This possibility was explored using a set of Y-DNA-markers allowing the identification of Y lineages occurring at high frequency in Finns. We characterized the Y haplogroups in 32 normal Finn males (control group) and 17 cases of testicular cancer in Finns with and without AZF deletions. We found no association between Y lineages and AZF microdeletions, nor between AZF microdeletions and a Y microdeletion ( DYS7C) exhibiting high prevalence (>50%) in Finns. The lack of correlation between AZF deletions and Y haplogroups indicates that the origin of these deletions is independent from the Y chromosome genetic background. No AZF deletions were found in familial cases of testicular tumors; hence, hereditary factors inducing the appearance of testicular malignancies in certain genealogies apparently do not increase the susceptibility to AZF deficiencies. AZF deletions are de novo events occurring in prezygotic or in post-zygotic stages. We propose that most AZF deletions associated with testicular tumors are due to post-zygotic Y microdeletions, while most cases of deletions associated with infertility are due to deletions occurring in the germ cell line of proband fathers.

Risk of esophageal, ovarian, testicular, kidney and bladder cancers and leukemia among finnish workers exposed to diesel or gasoline engine exhaust.

Occupational exposure to diesel exhaust has been classified as probably carcinogenic and that to gasoline engine exhaust as possibly carcinogenic to humans. Earlier results concerning cancers other than lung cancer are scarce and inconsistent, and exposure-response relations have seldom been reported. We followed up a cohort of all economically active Finns born between 1906 and 1945 for 30 million person-years during 1971-1995. Incident cases of esophageal cancer (n = 2,198), ovarian cancer (5,082), testicular cancer (387), kidney cancer (7,366), bladder cancer (8,110) and leukemia (4,562) were identified through a record linkage with the Finnish Cancer Registry. Occupations from the population census in 1970 were converted to exposures to diesel and gasoline engine exhausts with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as product of prevalence, level and estimated duration of exposure. The relative risk (RR) of cancer for exposure categories in relation to the unexposed group was calculated using the Poisson regression model and adjusted for confounders. An increasing RR for ovarian cancer was observed with the increasing CE of diesel exhaust (p for trend = 0.006). The RR in the highest CE category was 3.69 (95% CI = 1.38-9.86). For gasoline engine exhaust, the RR was significantly increased only in the middle CE category (1.70; 95% CI = 1.11-2.62). Slight elevations of RR for bladder and kidney cancers were found at the lowest exposure level of engine exhausts, largely attributable to drivers. No effect of the exposures was observed for the other cancers. This study suggests an exposure-response relation between diesel exhaust and ovarian cancer.

Birth weight, adult height, and testicular cancer: cohort study of 337,249 Swedish young men: Rasmussen F, Gunnell D, Ekbom A, Hallqvist J, Tynelius P, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.

Cancer Causes Control 2003;14:595–8 Objective A positive association has been reported between adult height and the incidence of testicular cancer. No previous study has explored whether this relationship is due to the influence of fetal growth on adult height. Methods This research question was studied in a Swedish national cohort comprising 337,249 males born 1973–1980 and followed-up for a mean of 4.8 years after army medical conscription examination. Cases of testicular cancer were ascertained from the Swedish National Cancer Register. 144 cases of testicular cancer (120 non-seminomas) diagnosed after conscription were identified. Results Positive associations were found between height at age 18 years and the incidence of testicular cancer. No associations were observed between gestational age adjusted birthweight and cancer incidence. The positive association between height and cancer incidence was not attenuated in models controlling for birth weight. Conclusions Factors influencing post-natal growth such as diet or growth related genes might underlie the association between height and cancer.

Testicular cancer metastatic exclusively to the brain and spleen

We report an unusual case of testicular cancer metastasized solely in the brain and spleen without retroperitoneal disease or other widespread metastasis. The patient initially presented with seizures and underwent craniotomy for presumed primary brain tumor, with a delayed diagnosis of testicular cancer as the true primary. This pattern of spread is highly unusual, and, to our knowledge, we report the first case of splenectomy performed for involvement by testicular cancer. At last follow-up, the patient was doing well, with no evidence of disease after 2 years.

Cancer risk in offspring of male pesticide applicators in agriculture in Sweden

Aims: To explore cancer risk from date of birth until 1994 in children, born 1958 or later, of Swedish male pesticide applicators. Methods: Records of male pesticide applicators licensed 1965–76...