How is the increased risk of testis cancer managed in cryptorchidism?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

In children or young adults who present late with cryptorchidism, some authors recommend initial management with orchiopexy while others advise proceeding directly to orchiectomy. Chung and Lee suggest an individualized approach to postpubertal cryptorchidism: offer orchiectomy, but if that is declined, perform orchiopexy followed by careful surveillance for malignant changes. In cases where convincing evidence exists of testicular descent at birth, with secondary ascent of the testis, they note that postpubertal orchiopexy may reduce the risk of infertility without increasing the risk of malignancy. [70]  

Giwercman et al recommend biopsy of all cryptorchid testes in adults. If carcinoma in situ (CIS) is present, they recommend contralateral biopsy and unilateral orchiectomy. If the remaining contralateral testis also harbors CIS, they recommend radiation therapy. [71]  

Lenz et al demonstrated an abnormal echo pattern in 3% of postpubertal testes that had undergone orchiopexy. This abnormal ultrasonographic finding may be associated with CIS, and they suggest offering scrotal ultrasonography to postpubertal patients. [72]


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