Frequency and management of germ-cell tumors in a third-world country

Since 1977, advances in the treatment of germ-cell tumors have resulted in a declining mortality from testicular cancer. Simultaneously, a rising incidence of disease was seen in many developed parts of world. However, the frequency of and mortality from testicular cancer have not been reported from any third-world country, where larger and younger populations at risk reside. The age-specific annual incidence of testicular cancer was calculated from information in the cancer registry of Iraq (1986-1988). The data on management of 29 patients with testicular (n=15) and nontesticular (n=14) germ-cell tumors were retrospectively analyzed (9% of all non-seminoma testicular cancers in the country for the 1984-1990 period). The annual incidence of testicular cancer is low in Iraq. Transscrotal biopsy and transscrotal orchiectomy were frequently performed but did not adversely affect patient outcome. A poor outcome was associated with the lack of surveillance after surgery; inappropriate sequencing of chemotherapy, surgery and radiation treatment; and chemotherapy of a low-dose intensity. Tumor marker studies were infrequently done. In conclusion, the annual incidence of testicular carcinoma in this developing country is low, but mortality appears high due to the incomplete penetration of the current medical knowledge into clinical practice.