Cryptorchidism & malignancy

Arry Rodjani
Department of Urology, Cipto Mangunkusumo General Hospital ,
Faculty of Medicine University of Indonesia
Jakarta
UroOncology Update , Feb 2010, Kempinsky Hotel Indonesia, Jakarta
Cryptorchidism
Why is it important ?
FERTILITY ISSUES
MALIGNANCY ISSUES
Cryptorchidism & malignancy
Questions . ?
1. What is the RR of testicular cancer in a cryptorchid
testis ?
2. In patients with unilateral cryptorchidism what is
the RR of testicular cancer in a contralateral,
normally DT?
3. Does testis location affect the subsequent
pathological subtype of testicular cancer?
4. Does orchidopexy decrease the risk of testicular
cancer?
5. Is there a risk of malignant degeneration for
testicular remnant?


What is the RR of testicular cancer in a cryptorchid testis ?

Textbooks Statement
Campbell-Walsh
urology, 9 th edition
It is well established fact that children born with UDT are at
increased risk for malignancy . the RR is approximately
40 times greater
Adult and Pediatric
Urology
the combined risk for all cryptorchid males, irrespective of
the location of the testis, has been calculated at 20 to 46
times greater than for patient with normally located testis
Pediatric Urology individuals born with an UDT have approximately a 40 fold
incidence of testicular malignancy over those born with
scrotal testis
Based on data between 1828 and 1927
Suggested a 0.23% incidence of UDT
11% (840 of 7000) testicular cancer
Generating 0.11/0.0023 = 48 fold
Recent data about UDT
Incidence of UDT: 1.1% and 1.6% at age 1 year

Testicular cancer with prior UDT: 5 10%



Dieckmann et al. World J Urol 2004;22:2
Kanto et al. Int J Urol 2004; 11:640
Prener et al. epidemiology 1996; 7:14
Suprabawati TE. Umbas R. Ind J Cancer 2007; 1:92-5
Wood H.M., Elder J.S: J Urol 181, 452-461, 2009
., there exists strong evidence that the risk of testis
cancer in cryptorchid and formerly cryptorchis testis is
most probably an order of magnitude less than that
initially estimated by Campbell, and..
The RR of testicular cancer in a cryptorchidism case is
2.75 to 8
What is the RR of testicular cancer in a contralateral,
normally DT?
Campbell-Walsh Urology ..: 5 10 %
Adult & Pediatric Urology : 10 %
Pediatric Urology .: 10 20 %
Wood H.M., Elder J.S: J Urol 181, 452-461, 2009
The risk of a tumor in the contralateral testis is similar
to that in the normal male population
Does testis location affect the subsequent
pathological subtype of testicular cancer?
Orchiopexy appears to decrease the risk of seminoma
Does orchiopexy decrease the risk of testicular cancer?
Sweden study
1965 2000
N= 17.000 men treated for UDT
56 ptns with testicular cancer

Pettersson et al. N Engl J Med 2007; 356: 1835
Age at orchiopexy The RR of testicular cancer
0 6
7 9 2.02 and 2.35
10 12
13 15 5.06
16 19 6.24
Does orchiopexy decrease the risk of testicular cancer?
Operation before 11 yo cancer RR is the same
Operation after 11 yo ----- RR x 32


Operation does not reduce RR for cancer
.. but delayed operation may increase RR

Herrinton 2003
Pinczowski et al. J Urol 1991; 146: 1291
Is there a risk of malignant degeneration in testicular
remnants?

Cryptorchidism
Cancer risk

Risk x 7.3 40
Risk increases in intra-abdominal UDT (50%)
Cancers in the contra lateral DT (?)
CIS in 2 3 % in UDT
Relative risk (RR) of testicular cancer in patient with history of cryptorchidism
Series No Relative risk (RR)
Pottern et al 271 3.7 (1.6 8.6)
Giwereman et al 506 4.7 (1.7 10.2)
Pinczowski et al 2918 7.4 (2.0 19.0)
Swerdlow et al 1075 7.5 (3.9 12.8)
Herrinton et al 183 4.8 (1.9 11.8)
Operation before 11 yo cancer RR is the same
Operation after 11 yo ----- RR x 32

Herrinton 2003
Operation does not reduce RR for cancer
.. but delayed operation may increase RR