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Introduction: Survival of patients with testicular cancer has changed dramatically over the last two decades. This is mainly related to more successful chemotherapy, using combinations of drugs including cisplatinum. Therapy with cisplatinum was started in 1978 in Iceland. The survival of Icelandic men with non-seminoma testicular cancer, before and after this change in therapy, is not known., Objective: Therefore a retrospective population-based study was carried out on all Icelandic males diagnosed with non-seminoma testicular cancer between 1971 and 1995., Material and Methods: Fifty-seven males with an average age of 29.1 years (range 17-52) were included in the study. Clinical information was obtained from the Icelandic Cancer Registry and hospital records. All specimens were reexamined by a pathologist and the modified staging system of Boden and Gibb was used for staging the disease. Crude survival was evaluated with the Kaplan-Meier method., Results: Age standardized incidence for non-seminoma testicular cancer was 1.8 / 100,000 males per year for the whole period. Among the 57 patients, testicular swelling (93%) and pain (56%) were the most common symptoms at diagnosis. All 57 patients underwent orchiectomy, and 37 received chemotherapy as well. The most common histological type was embryonal carcinoma (44%) and average tumor diameter was 4.3 cm with a range of 1-12 cm. Tventy-six (51%) patients had stage I disease at diagnosis but 10 (17%) had stage IV. Crude five and 10 year survival for the whole group was 85% and 83%. From 1971 to 1977 the crude five year survival was 36% but 98% for the period 1978-1995. In December 1995 seven (64%) of 11 patients diagnosed between 1971-1977 have died of the disease. On the other hand only two patients (4%) diagnosed after 1977 have died as of december 1995. One because of acute myelogenic leukemia, nearly seven years after diagnosis of testis cancer. The other died of teratocarcinoma 12 months after diagnosis despite intensive chemotherapy including cisplatinum., Conclusion: Survival of patients with non-seminoma testicular cancer in Iceland has improved dramatically after the introduction of cisplatinum based chemotherapy in 1978. Of 46 patients diagnosed after 1977 only one (2%) has died because of the disease and median follow up was eight years. The incidence is low compared to other Western countries if Norway and Danmark are not included, were the incidence is much higher. Clinical presentation of the disease is similar between these countries.

Testicular cancer is the most common cancer diagnosed in males aged 20 to 34 in Iceland. A retrospective population-based study was carried out on all Icelandic males diagnosed between 1971 and 1990 to evaluate presentation and survival of seminoma in Iceland. Fortyseven males with average age of 36 years (range 21-71) were included. Clinical informations were gained from the Icelandic Cancer Registry and hospital records. The staging system used was a modification of the system orginally proposed by Boden and Gibb and crude probability of survival was evaluated with the Kaplan-Meier method. Age standardized incidence for seminoma was 2.0/ 100,000 males per year for the whole period. Forty-five patients were diagnosed with symptoms where testicular swelling (98%) and pain (42%) were the most common symptoms. Two patients were diagnosed incidentally. All the patients except one underwent orchiectomy, 66% also received radiotherapy and 9% chemotherapy. Average tumor diameter was 8 cm before 1981 but 5.2 cm after 1981 (p=0.02). Most patients were diagnosed in stage I (73%), but 27% had disseminated disease at diagnosis (stage II-IV), most commonly retroperitoneal lymphnode metastases (85%). Crude five and 10 year survival was 89% and 84% respectively. Nine patients have died (August 1994) but none of seminoma. The incidence of seminoma is moderate in Iceland compared to the Nordic countries. Clinical symptoms and stage at diagnosis are similar. Survival is excellent for the group as a whole. For small localized tumors orchiectomy and surveillance seem to be an appropriate approach.