There are four well-established risk factors for testis cancer:
- Cryptorchidism (an undescended testicle)
- Family History
- Personal History
- Intratubular germ cell neoplasia (ITGCN)
The most common risk factor for testis cancer is a history of cryptorchidism, otherwise known as anundescended testicle. Normally in the developing male fetus, the testicles form near the kidneys in the abdomen (belly). About the eight month of pregnancy, the testicles descend, exit the body and settle in the scrotum. About 3% of boys will have one or both testicles that fail to make it into the scrotum. Testicles can settle in the abdomen or in the inguinal canal or groin (where the testicle exits the body wall and enters the scrotum). Most of the time, an undescended testicle will move down and settle into the scrotum within the first year of life. Sometimes, surgery is required to bring down and fix the testicle to the scrotum – this surgery is called an orchiopexy.
Boys with a history of cryptorchidism have an increased risk of testis cancer. The risk of cancer is not directly related to the fact that the testicle does not descend, but it is believed that the abnormality in descent likely indicates an abnormality in the testicle that makes cancer more likely. This belief is based on the following observations. The cancer usually develops in the undescended testicle (4 to 6-fold increased risk of cancer), but the risk of cancer is also higher in the normal testicle (less than 2-fold increased risk). In addition, generally the higher the testicle, the higher the risk of testis cancer – intra-abdominal testis have a much higher risk of cancer than those in the inguinal canal. Early surgery (orchiopexy) reduces the risk of testis cancer (2 to 3-fold risk if the surgery is performed prior to puberty), but does not erase the chance for that boy to develop cancer later in life.
A family history of testicular cancer is another common risk factor with an 8 to 12-fold risk if a brother with testis cancer and a 2 to 4-fold risk if father with testis cancer. In addition, the average age at diagnosis is 2-3 years younger than general population if a first-degree relative has testicular cancer. However, it should be remembered that testis cancer is rare and it is therefore rare for this disease to run in families.
Men with a personal history of testicular cancer have the highest-risk of developing another cancer. Fortunately, only 2% of men with develop cancer in both testicles, but that risk is 12-fold higher than men without testis cancer. In addition, men who develop testis cancer in their 20’s or earlier, men with seminoma and men with intratubular germ cell neoplasia (ITGCN) have a higher risk of developing a second testis cancer.
Most testis cancer arise from the precursor lesion known as ITGCN (or carcinoma-in-situ, CIS). ITGCN is present adjacent to testis cancer in 80-90% of patients. For men in whom ITGCN is found for other reasons, the risk of subsequent testis cancer is 50% at 5 years and 70% at 7 years. Therefore, ITGCN is the last well-known risk factor for testis cancer.
Other potential, but not established risk factors for testis cancer include: HIV infection, body type (tall men may be more likely to develop testis cancer) and a history of trauma to the testicles.