Testicular cancer

What is it?

Testicular cancer is a relatively rare disease, accounting for about 1-1.5% of neoplasms in men and 5% of urological neoplasms in general. Testicular cancer most often affects young men and is the most common cancer between the ages of 15 and 40. In Western society, the incidence of the disease has been increasing over the past few decades and is about 10 new cases per 100,000 people per year. Recognized risk factors for testicular cancer include cryptorchidism (the testis remains in the abdominal cavity or inguinal canal at birth), prior testicular cancer (in 2-3% of cases, testicular cancer can occur simultaneously or at a distance in both testicles), Klinefelter syndrome, testicular hypotrophy, a family history of testicular neoplasia and male infertility. Various histological forms are known, with a significant preponderance (95%) of germ cell tumors (arising from the reproductive cell population of the seminal tubules) over stromal tumors (arising from the rest of the testicular cell population). Testicular germ cell tumors are divided into seminomatous and nonseminomatous, this is a histologic classification that is of great therapeutic importance.

Which are the symptoms?

In most cases, the tumor appears as a hard, non-painful lump in the testicle; in 10% of cases, it is associated with pain in the testicle or complaints already caused by its metastatic location, and in only 5% of cases it is associated with gynecomastia (development of male breast).

  • Hard, non-mobile lump on one testicle
  • Testicular pain
  • Gynecomastia       

How is it diagnosed?

Therefore, periodic self-palpation of the testicles, starting in adolescence, is recommended for all boys. Objective examination by a urologist and testicular ultrasound will allow proper differential diagnosis with other benign scrotal pathology (acute or chronic epididymitis, hydrocele, appendage cysts), helping confirm a testicular cancer diagnosis. The staging of testicular cancer, that is, determining its characteristics and degree of spread, is done by: 1) blood tests for some specific and sensitive tumor markers (α-fetoprotein and β-HCG); 2) orchifuniculectomy (testicular removal) performed by the inguinal method, which allows removal of the primary tumor and histological evaluation; and 3) performing chest and abdominal CT scans with contrast agent to be able to determine whether secondary localizations at lymph node or other organ levels are present. Testicular cancer cells are characterized by rapid growth, and secondary spread of the tumor can occur through the lymphatic tract, involving retroperitoneal lymph nodes (located along large vessels near the posterior abdominal wall) or through the blood, with metastases in decreasing frequency in the lungs, liver and brain (rarely and late in the bones).

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How is it treated?

Despite their high biological activity (30% of testicular tumors present with metastatic disease at diagnosis), germ cell tumors demonstrate high sensitivity to chemotherapy and a very good response to multimodality treatment (surgery, chemotherapy, radiotherapy). These features lead to a high cure rate, about 99% in localized testicular disease and 90%, 75-80% and 50% in advanced stages, defined as “good”, “intermediate” and “poor” prognosis, respectively. Histology and tumor stage (localization in the testicle, retroperitoneal lymph node involvement, or metastases to other sites) determine the course of treatment after orchifuniculectomy (radiotherapy, chemotherapy, or retroperitoneal lymph node removal) and follow-up. The high survival rate and long life expectancy of patients have led to an increasing focus on early and late effects of cancer treatment, especially with regard to preserving reproductive function and overall human well-being (selective radiotherapy techniques, reduced dose of chemotherapy, nerve-sparing retroperitoneal lymphadenectomy techniques, cryopreservation of seminal liquid).

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