Testicular germ cell carcinoma is a disease of young men. Although treatment has improved dramatically in recent decades, some groups of men have not benefited fully from these advances, and survivors remain at risk for numerous subsequent problems. The incidence of testicular cancer has been rising steadily for decades. This temporal trend is attributed to changing patterns of exposure to risk factors, but specific environmental agents responsible for the increasing rates have not been identified. The two established risk factors are cryptorchidism and family history of testicu-lar cancer. A distinctive age distribution and reported birth cohort effects suggest that critical events that contribute to the pathophysiology of testicular cancer may occur early in life and again at about the time of puberty. Both environmental and genetic factors are believed to be important. Genetic effects seem to operate both by inherited predisposition and by acquired chromosomal changes leading to deregulated gene expression. Although chromosomal regions have been implicated in both processes, the responsible genes and their mechanisms of action have not been identified. Taken together, these observations suggest several causal hypotheses that are being explored by using proxy measures of past exposures and by newer techniques of genetics and molecular biology.
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