What are the other Names for this Condition? (Also known as/Synonyms)

• Choriocarcinoma of the Testicles
• Testicular Choriocarcinoma

What is Choriocarcinoma of the Testis? (Definition/Background Information)

• Choriocarcinoma of the Testis is an aggressive type of testicular cancer affecting the germ cells. Germ cells are precursors to sperm cells that will eventually transform into sperms
• The testes are the male reproductive organs, equivalent to the ovaries in women. They are housed in the scrotum; the sac-like structure in the groin. The testis have 2 main functions:
  • Male hormone production
  • Sperm production
• Testicular cancer is cancer of the testicle, or testis. It is the most common form of cancer in young men aged 15-35 years. It is generally aggressive, but treatable when identified early
• More than 90% of testicular cancers arise from abnormalities in the germ cells. Germ cells are one of the two types of cells in the body. They form sex cells - the sperms and eggs, while the other type, somatic cells, forms everything else (all other body organs and parts)
• Normal germ cells arise from pluripotent stem cells. Pluripotent stem cells can differentiate into, or become, any cell in the body. Thus, pluripotent stem cells may become either germ cells or somatic cells
• The process of pluripotent stem cells becoming other cell types is mediated by chemical signaling. Chemicals that act as signals include growth factors, nutrients, and hormones
• Stem cells that do not respond to normal signals may grow uncontrollably and cause tumors. This tumor-causing potential makes them “neoplastic”. Neoplastic cells that grow aggressively and spread to other areas are cancerous
• There are two types of testicular cancer:
  • Seminoma: It is a slow-growing cancer affecting men in their 30s and 40s, which is usually confined to the testis. These are of 2 types - classical and spermatocytic seminoma
  • Nonseminoma: It is a fast-growing cancer affecting males in their late teens through 30s, which aggressively metastasizes, or spreads. These are of 4 types - embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma         
• Choriocarcinoma of the Testis is a rare and very aggressive form of testicular cancer. It is likely to spread, or metastasize, to other parts of the body. It may cause internal bleeding (hemorrhaging) and cell death (necrosis), as it damages the surrounding tissues
• The cause for Choriocarcinoma of the Testis, unlike that of the ova, is unknown. It is the most dangerous of the nonseminomas. However, it is rarely pure and is often ‘mixed’ with other nonseminomas. The more it is mixed, the better is the outcome

Who gets Choriocarcinoma of the Testis? (Age and Sex Distribution)

Males at risk for Choriocarcinoma of the Testis include:

• Individuals in their late teens (around 17-19 years) through the early 30s
• Caucasians

What are the Risk Factors for Choriocarcinoma of the Testis? (Predisposing Factors)

Following are factors that increase one’s susceptibility to Choriocarcinoma of the Testis:

• Family history of testicular cancer
• Caucasian descent
• Age 25 to 35 years
• Undescended testes in youth
• Decreased immunity, especially due to HIV/AIDS
• Kidney transplant
• Presence of carcinoma in situ (CIS), or intra-tubular germ cell neoplasia
• Hypospadias (male birth defect affecting the urethra)
• Inguinal hernia
• Testicular atrophy
• Gonadal dysgenesis
• Infertility
• Smoking
• Exposure to radiation and industrial chemicals
• Chemotherapy
• Viruses (in some rare cases)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Choriocarcinoma of the Testis? (Etiology)

The cause of Choriocarcinoma of the Testis is unknown.

• It is believed that abnormal differentiation of germ cells gives rise to cancerous cells that lead to the formation of this condition
• However, how this occurs and the factors that cause it remain under investigation

What are the Signs and Symptoms of Choriocarcinoma of the Testis?

Indications for Choriocarcinoma of the Testis include:

• Blood in vomit and cough
• Blood in stool, urine
• Trouble breathing
• Headache
• Low blood pressure
• Anemia
• Testicular pain, lump in the testes, feeling of heaviness in the scrotum
• Abdominal pain and swelling
• Breast pain, especially if accompanied by enlargement
• Back pain
• Swelling of the legs
• Constipation
• Changes in appetite
• Fatigue
• Frequent urination
• Paralysis

How is Choriocarcinoma of the Testis Diagnosed?

Following are techniques that aid in identifying Choriocarcinoma of the Testis:

• Physical examination to detect lumps in the testicles, which do not allow light to pass through
• Tissue biopsy followed by microscopic analysis and staining
• Blood tests that include:
  • Complete blood cell count (CBC) blood test
  • Liver function blood test (LFT)      
  • Serum tumor marker blood test to detect increases in human chorionic gonadotropin (hCG)
  • Alpha-fetoprotein (AFP) blood test
  • Lactate dehydrogenase (LDH) blood test
  • Testosterone levels blood test
• Genetic testing to determine mutations associated with Testicular Choriocarcinoma
• Radiological imaging including:
  • X-ray of the chest, abdomen, and pelvis
  • Ultrasound of the pelvis        
  • Computerized tomography (CT) scan of the brain
  • Vascular radiological studies
  • Whole body bone scan
  • Positron emission tomography (PET) scan 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Choriocarcinoma of the Testis?

Following are complications that may arise from Choriocarcinoma of the Testis:

• Infertility
• Retrograde ejaculation
• Excessive blood loss
• Metastasis and the loss of function of the organ/area to which the cancer has spread; the cancer mostly metastasizes to the brain and lung
• Tumor recurrence after treatment

How is Choriocarcinoma of the Testis Treated?

Treatments for Choriocarcinoma of the Testis may include the following procedures:

• Removal of the original tumor and the metastatic tumors
• Removal of the testis
• Debulking surgery to reduce tumor size, followed by chemotherapy
• Clotting the vessels in the tumor (embolization)
• Chemotherapy
• Radiotherapy
• Undertaking treatment of underlying conditions

How can Choriocarcinoma of the Testis be Prevented?

In some cases, Choriocarcinoma of the Testis may be avoided through the following measures:

• Monthly testicular self-examination
• Genetic testing in individuals with a family history
• Limiting exposure to radiation and industrial chemicals
• Limiting chemotherapy
• Not smoking

What is the Prognosis of Choriocarcinoma of the Testis? (Outcomes/Resolutions)

• Choriocarcinoma of the Testis is a highly malignant tumor that often goes unnoticed, until the malignancy spreads to other parts of the body, at which point it is at an advanced stage. Moreover, the recurrence rate of the tumor is also high
• The following factors determine the prognosis of the condition:
  • Size of the tumor
  • Stage of the tumor
  • Age of the individual
  • Overall health of the individual
  • Tumor location in the testes
  • Number of tumor masses present within the testes
• The overall prognosis of Choriocarcinoma of the Testis is generally much worse than testicular germ cell tumors. It is reported that the 5-year survival rate for Testicular Choriocarcinoma is 80% or even lower 

Additional and Relevant Useful Information for Choriocarcinoma of the Testis:

• Testicular cancers are aggressive in nature; they are also very quick to develop. Nonetheless, they are readily treatable
• Choriocarcinoma may occur with other forms of testicular cancers. This is less dangerous than ‘pure’ choriocarcinoma
• Seminoma of testis, embryonal carcinoma of testis, teratoma of testis, and yolk sac tumor all arise from germ cells. But, Choriocarcinoma of Testis arises from germ cells that have differentiated in synctiotrophoblasts and cytotrophoblasts
• Testicular cancer is the most common form of cancer in US men aged 15 to 35 years. However, it is still relatively uncommon, with 5,500 cases in the US each year and 0.2-10.3 cases worldwide per 100,000 persons