Testicular neoplasms in Kenyan Africans

Current concepts about testicular cancer

In the past 20 years, testicular cancer, which occurs in the young, has become a curable malignancy; 90% of the patients treated will achieve long-term survival. However, there is a significant morbidity associated with the management of the disease process. The literature was reviewed concerning the current treatment strategies and prognosis, as well as the long-term sequelae of the various diagnostic and therapeutic procedures. Surveillance has become a key element in the management of patients with a primary (stage I) testicular non-seminoma. Although approximately 25% of these patients will relapse, 100% survival can be achieved with cisplatin in combination with etoposide and bleomycin (BEP). Patients with a disseminated non-seminoma are usually treated with 4 courses of BEP; an 80% survival rate can be achieved. The long-term effects of chemotherapy include Raynaud's phenomenon, acral paraesthesia, hyperlipidaemia, nephrotoxicity, infertility and hormonal disturbances. Retroperitoneal lymph node dissection or resection of residual disease following chemotherapy are associated with a low mortality and morbidity rate, ejaculatory dysfunction excepted. However, with specific modifications in technique (e.g. nerve-sparing) antegrade ejaculation can be preserved in the majority of patients. Radiotherapy is used in stage I and II seminoma. With the conventional dose of 25-30 Gy to the retroperitoneal and ipsilateral iliac lymph nodes, temporary dysfunction of the germ and Leydig cells of the remaining testis may occur by scatter radiation. Patients with advanced seminoma are treated with cisplatin-based chemotherapy. To date, testicular cancer patients can receive appropriate curative treatment with acceptable acute toxicity, depending on the therapy given. The detrimental effects of late toxicities require careful study and follow-up. However, little attention is paid currently to quality of life aspects, in particular the impact of the disease and its treatment on general well-being, including sexual function.

Testicular cancer in blacks. A multicenter experience

BACKGROUND

The rarity of testis tumor in black patients has made the study of a large series difficult. Much of the epidemiologic and clinical information regarding this neoplasm in this population is in dispute, including data on incidence, prognosis, histologic distribution, age and stage at presentation, and side distribution.

METHODS

A retrospective review of 66 blacks with testicular tumors from seven military medical centers was performed.

RESULTS

Similar results were found for blacks with testis tumor to those of the general testis cancer population regarding prognosis, side distribution, and age of onset for nonseminoma and interstitial tumors. There is a slight increase in the expected number of interstitial tumors in blacks, but the distribution between seminoma and nonseminoma is similar to the general population. The mean age of presentation for seminoma in blacks was younger than that of the general testis cancer population. For testis tumor treated at the same institution, there was an increased delay of diagnosis in blacks compared with whites. The number of new cases of testicular cancer between 1979 and 1991 at one major center was increased for whites but not for blacks. The availability of cisplatin-based combination chemotherapy has resulted in an improved prognosis for blacks, as has already been demonstrated for white populations.

CONCLUSIONS

Testis tumor in blacks behaves similarly to testis tumor in the general population except that in blacks there are more interstitial tumors and the mean age of presentation for seminoma is younger. Further, there is an increased delay in diagnosis for blacks compared with whites, but the incidence of this tumor in this population does not appear to be increasing. Cisplatin-based chemotherapy has significantly improved survival in this population.

Pattern of urological malignancy in Zambia. A hospital-based histopathological study

The pattern of urological malignancy among the indigenous population of Zambia (determined on the basis of histopathological reports from a major national hospital during an 8-year period) is presented. A total of 6514 malignancies were observed, of which 784 (12%) were of urological origin. Bladder carcinoma, predominantly squamous type, was the commonest urological tumour (51%), followed by carcinoma of the prostate (26%), carcinoma of the penis (18%), renal tumours (4.3%) and testicular malignancy (0.7%). In nearly 32% of the bladder tumours, bilharzial ova were demonstrated histopathologically. Nephroblastoma accounted for 70% of the renal tumours and from a total of 7 cases of testicular tumours 5 were embryonal carcinoma and 2 seminoma. A brief reference is made to the pattern and aetiology of urological malignancies in some neighbouring countries.

Testicular tumor in blacks

Although testicular tumors are less common in blacks than in whites, they do occur and must be considered in making a differential diagnosis of scrotal masses. At The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston, 19 black men were treated for testicular tumor between 1944 and 1980, representing 1.4 per cent of the total of 1,380 patients treated for testicular tumor. Since blacks made up 7.9 per cent of all patients treated at UT M. D. Anderson Hospital, blacks with testicular tumor were seen about one-fifth as often as would be expected if there were no racial variation in the incidence of the disease. Twelve patients had a diagnosis of seminoma, five embryonal carcinoma, one teratocarcinoma, and one interstitial cell tumor. The majority of patients had metastatic disease at the time of diagnosis. Five of 12 patients with seminoma and 5 of 6 with nonseminomatous cancer died of disease. Prognosis today, however, is no worse for blacks than for whites.

Orchidectomy in a rural African population

From 1971 to 1977 in Zaria, Nigeria, orchidectomy was performed on 341 men, mostly in the third to sixth decades of life. The testis itself was diseased only in 21% of cases. Torsion of the spermatic cord with testicular infarction occurred in 11% and cancer was present in less than 2%. Orchidectomy was performed therapeutically in 5% of the patients. The major causes for testicular resection were complicated and large inguinal herniae and hydroceles. These two conditions are a source of socio-economic hardship and considerable morbidity in a farming population. It would thus be worth while to include facilities for surgery of small herniae and hydroceles in plans for rural health care.