Testicular cancer: symptoms, early diagnosis, and treatment

Testicular cancer is characterized by the abnormal proliferation of cells within the testicle.

“From a histological standpoint, testicular tumors are mainly divided into seminomas and non-seminomas.

• Seminomas tend to grow slowly and generally respond well to radiotherapy and chemotherapy;
• Non-seminomas (including embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumor) grow faster and often require a more aggressive therapeutic approach,” explains Dr. Colalillo.

The main conditions that increase the risk of developing testicular cancer include:

• Cryptorchidism (failure of one or both testicles to descend into the scrotum, remaining in the abdomen or groin);
• Family history of testicular cancer;
• Certain genetic alterations;
• Syndromes such as Klinefelter syndrome, a chromosomal abnormality;
• Previous testicular cancer, which increases the risk of developing a tumor in the contralateral testicle.

Learning to recognize early warning signs is the first step toward the prompt identification of a potential testicular tumor.

According to Dr. Gaia Colalillo the most common symptoms include:

• A painless lump or swelling within the testicle;
• A feeling of heaviness in the scrotum;
• Dull or sudden pain;
• Changes in size or consistency of the testicle.

Additionally, Dr. Colalillo emphasizes that “Not all testicular nodules are cancerous, but any suspicious change requires prompt urological evaluation.”

The first and simplest form of prevention against testicular cancer is testicular self-examination, a practice that should begin in adolescence.

“The European Association of Urology recommends monthly self-examination, ideally performed with soap while showering, to familiarize oneself with the normal texture and volume of the testicles. This helps to detect any unusual lumps early,” explains Dr. Colalillo.

In addition to self-checks, preventive measures include:

• Timely treatment of conditions that may predispose to testicular cancer, such as cryptorchidism;
• Maintaining a healthy lifestyle and a balanced diet, limiting foods high in saturated fats, which promote inflammation, a precursor event in many types of cancer.

Men and adolescents should know the normal size and feel of their testicles by performing self-examination:

• At least once a month;
• During or after a warm shower or bath, when the scrotal skin is relaxed;
• Gently rolling each testicle between the thumb and fingers.

This simple procedure can make the difference in early diagnosis.

“In the past, testicular examination was part of mandatory military medical screening, which allowed early detection of testicular tumors. Since compulsory military service has been abolished, it’s crucial that young men learn to perform this check themselves,” emphasizes Dr. Colalillo.

Early diagnosis relies on:

• Urological examination (palpation to detect any suspicious nodules);
• Testicular ultrasound;
• Blood tests to measure tumor markers such as AFP (alpha-fetoprotein), beta-hCG, and LDH;
• CT scan of the abdomen and chest for staging;
• Orchifunicolectomy (surgical removal of the testicle and spermatic cord) for histological confirmation.

Treatment varies according to the tumor type, the stage of the disease, and the levels of tumor markers.

According to Dr. Colalillo, surgery represents the first-line treatment in the vast majority of cases.

The next therapeutic steps depend primarily on:

• Histological findings, which define the cellular characteristics of the tumor;
• Disease staging, meaning whether the tumor is confined to the testicle or has spread elsewhere.

Dr. Colalillo explains:

“In early-stage seminomas, treatment options may include active surveillance, radiotherapy, or prophylactic chemotherapy.

In early-stage non-seminomas, management may involve surveillance, adjuvant chemotherapy, or retroperitoneal lymph node dissection, depending on the risk of recurrence.

In advanced or metastatic tumors, chemotherapy is considered the standard of care.

Additionally, in seminomas with retroperitoneal lymph node involvement, radiotherapy may be indicated.”

“An orchifunicolectomy involves removal of the affected testicle along with the spermatic cord. The procedure is performed through a small inguinal incision, rather than through the scrotum, to minimize the risk of tumor cell dissemination,” explains Dr. Colalillo.

The operation lasts about one hour and is performed under general or spinal anesthesia.

Once removed, the testicle is sent for histopathological examination to confirm the diagnosis and guide further treatment if needed.

During the same procedure, a testicular prosthesis can be inserted to preserve the aesthetic appearance of the scrotum.

Post-treatment follow-up varies depending on tumor type and stage but typically includes:

• Regular clinical evaluations;
• Monitoring of tumor markers;
• Ultrasound and CT scans.

“It’s important to emphasize that every clinical case should be discussed within a multidisciplinary team, including urologists, oncologists, radiotherapists, and radiologists, in order to identify the most appropriate, individualized therapeutic approach,” concludes Dr. Colalillo.