Testicular cancer is a disease, which arises, when cancer (malignant) cells develop in the tissues of the testicles. Testicular cancer can occur at any age, but most often seen in younger men – between 20 and 45 years. The most common symptom of testicular cancer is a lump in the testicle, which can be painful.
The prognosis for most men with testicular cancer is very good. This form of cancer is successfully treated in more than 95% of the cases. While the risk of developing this type of cancer is 1 on 300, the probability of death from the disease is approx 1 on 5000.
There are several basic methods of diagnosis and screening for testicular cancer. But experts recommend every woman over 40 years of age without family burden to perform home examinations at least once a month.
The good news is, that in five-year survival, which in 1900. it was barely 5%, in 1990. got up 50%, reached levels of 84% – 87% nowadays. This is due to the advent of all modern methods, which are related to the genetic profiling of patients and help to personalize their treatment, maximum improvement and prolongation of their survival.
- A lump or swelling in the testicle. If detected early, the testicular tumor may be the size of a pea, which increases significantly over time;
- Pain or discomfort, with or without swelling in the testicles or scrotum;
- A change in manner, on which the testicle is felt or a feeling of heaviness in the scrotum.
- Mild pain in the lower abdomen or groin;
- Sudden accumulation of fluid in the scrotum;
- Breast tenderness and/or growth. Although they are rare, some testicular tumors produce hormones, which cause breast tenderness and enlargement – condition, called gynecomastia;
- Back pain, out of breath, chest pain, bloody or purulent sputum can be symptoms of later stage testicular cancer;
- Swelling in one or both legs or shortness of breath, due to thrombosis may be a symptom of testicular cancer..
- Many of the symptoms of testicular cancer can also be caused by non-cancerous conditions. for example: change in size or lump in the testicle: cyst, called a spermatocele, which develops in the epididymis; dilation of the blood vessels of the testicle, called a varicocele; the accumulation of fluid in the membrane around the testicle is called a hydrocele; hernia; injury or trauma; twisting.
The following factors can increase the risk of developing testicular cancer, although, that the cause is still unknown.
- Age. More than half of those diagnosed with testicular cancer are between the ages of 20 and 45 years. But that doesn't mean, that men in their teenage years or around the age of 60 cannot get the disease. That's why it's important that anyone with symptoms of testicular cancer see a doctor, regardless of age.
Cryptorchidism. It's a condition, in which one or both testicles do not move down into the scrotum before birth, as is generally the case. Men with cryptorchidism have an increased risk of developing testicular cancer. This risk can be reduced, if surgery is performed to correct the condition before the boy reaches puberty.
- Family burden. Person, who has a close relative, especially brother, who has had testicular cancer, there is an increased risk of development.
- Data on cancer of one testicle. The men, who had cancer of one testicle, have an increased risk of developing cancer in each other.
- Race. Although all men, regardless of race can get testicular cancer, it is more common in white men. Testicular cancer is rare in dark-skinned men, but with them the probability of a fatal outcome is greater, especially if the cancer has already spread to the lymph nodes or other parts of the body when diagnosed.
- Human immunodeficiency virus (HIV). Men with HIV or acquired immunodeficiency syndrome (AIDS), caused by the HIV virus, have slightly increased from the development of a seminoma tumor.
Diagnostics and screening
Testicular cancer is commonly diagnosed, after the patient notices a lump or other change in the testicles. Diagnosis involves a physical examination and ultrasound examination of the scrotum. Ultrasound helps the doctor determine if there is a tumor in the testicles. If the ultrasound examination shows the presence of a tumor formation, an operation to remove the testicle is planned, which is examined under a microscope for the presence of cancer and its type. Testicular cancer is diagnosed only after the testicle is removed and examined. A testicular biopsy is not performed, as it may compromise cancer treatment.
Tests to diagnose testicular cancer may include::
- Physical examination and history: A physical exam and medical history help the doctor identify problems, which may be associated with testicular cancer.
- Ultrasound: The ultrasound procedure reproduces an image of the body's tissues, using high-energy sound waves.
Serum tumor marker test: This procedure examines a blood sample to measure the amount of
- certain substances, associated with some types of cancer. These substances are called tumor markers. Tumor markers, which may account for elevated levels in testicular cancer, include alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG).
- Computed tomography (KТ): A CT scan is a medical examination, which uses x-rays, to reproduce an image of the inside of the body. When cancer is diagnosed or suspected, a CT scan shows whether the cancer has spread elsewhere in the body. Abdominal CT is performed for testicular cancer, pelvis and lung.
- PET scanner: Positron emission tomography (ПET) is a unique image reproduction technology, which helps doctors assess whether the organs and tissues inside the body are functioning. A PET scanner can measure vital functions such as blood flow, oxygen used and glucose metabolism, which helps doctors identify deviations from the normal function of organs and tissues. A PET scan is usually not appropriate for men with testicular cancer, but is sometimes used after chemotherapy in men with pure seminomas.
Types of testicular cancer
Almost all types of testicular cancer arise in the germ cells (these, which become spermatozoa). The main types of testicular tumors are seminomas and non-seminomas. Seminomas are slow-growing and usually confined to the testicle. Non-seminomas are slightly faster growing and spreading. Seminomas are more sensitive to radiation (radiotherapy), and both types are very sensitive to chemotherapy. If a testicular tumor has both seminoma, as well as non-seminoma cells, it is treated as non-seminous. Treatment is determined by the extent of the disease, the type of testicular cancer and the patient's preferences, when possible.
After the diagnosis of testicular cancer is made, additional tests and surgery are prescribed at the discretion of the specialists. It is necessary to determine the type of cancer and whether it has spread. Within this process, called staging, doctors draw up the most suitable treatment plan for you.
After a diagnosis of testicular cancer, doctors will remove the affected testicle. However, the other testicle usually remains healthy and often able to produce enough sperm, to become a father.
Radiation and chemotherapy are threats to male fertility, but there are several steps, which your doctor can take, to preserve your reproductive capacity. For example, doctors can adjust radiation doses and use special devices, with which to protect the healthy testicle. Even when treatment includes chemotherapy, fertility is often restored, although this process may take some time. The current recommendation is not to become a father for at least two years after the end of treatment for testicular cancer, since and chemo, and radiation therapy can cause temporary damage to sperm.
- Observation: Sometimes called "watchful waiting", or the so-called. active monitoring, used for low-grade seminomas and non-seminomas, after testicular surgery.
The three main types of treatment for testicular cancer are::
- Surgical: This treatment involves removing the testicle (inguinal orchiectomy) and is sometimes associated with removal of lymph nodes (lymph node dissection). Orchiectomy is performed as in seminoma, as well as in non-seminomal testicular cancer. Surgery can also be performed in certain situations to remove tumors from the lungs, liver or other organs, if they have not disappeared after chemotherapy.
- Radiation therapy: This treatment uses high-dose X-rays. Radiation may be used after surgery in patients with seminoma to prevent tumor recurrence.. Radiation therapy is usually limited to the treatment of seminoma tumors. Radiation therapy may be given as a prophylactic measure (adjuvant radiation therapy) or when there are clearly involved lymph nodes in the abdomen. In general, seminomas are very sensitive to radiation therapy, while non-seminoma tumors are not.
- Chemotherapy: This therapy uses drugs, which kill cancer cells or stop them from dividing. Chemotherapy improves survival in patients with both seminomas, so with non-seminomas. Chemotherapy drugs kill cancer cells, but they also harm some normal cells, leading to adverse reactions. They depend on the type of drugs used, their quantity and duration of treatment. Your doctor will decide which chemotherapy is best for you after carefully discussing the benefits and potential side effects.
Treatment according to stage
In stage one testicular cancer, the tumor is confined to the testicle itself. After the initial operation to remove the testicle, further treatment depends on whether the tumor is seminoma or non-seminoma.
At the seminomas we have a total of three options:
- Patient follow-up with regular abdominal CT scans and tumor markers.
- Short prophylactic course radiotherapy of the abdominal lymph nodes.
- One cycle of chemotherapy.
Each of these three approaches has its advantages and disadvantages, which you will discuss with your doctor.
At non-seminoma tumors depending on whether there are adverse prognostic factors on histology and what happened to the tumor markers after surgery the two options are:
- Careful follow-up with regular CT scans and tumor markers.
- Relatively aggressive chemotherapy.
At this stage, in addition to the tumor in the testicle, we also have involvement of the lymph nodes in the abdomen. Again, whether it is a seminoma or a non-seminoma tumor determines the approach, as well as to a large extent the treatment after the removal of the testicle depends on the size of the lymph nodes.
With seminoma, if the lymph nodes are not particularly large (to 3 cm.), radiation therapy to slightly higher doses than these, used at stage 1, can cure the tumor. In lymph nodes above 4 cm combined chemotherapy is preferred, significantly more aggressive than this one, which is sometimes used in staging 1.
For non-seminoma tumors, combined aggressive chemotherapy is the only option, providing a chance for a long-term cure. Tumor markers are very important in monitoring response to chemotherapy.
After chemotherapy, there may be residual formations at the site of the involved lymph nodes.
Residual formations at the site of lymph nodes can be observed in seminoma tumors, if they are negative on a PET scan. If they are PET positive, are usually irradiated.
Residual formations in non-seminoma tumors can be observed, if they are small and if the tumor markers are negative. Increase in tumor markers, growing formations, especially over 1cm in size, usually undergo surgical removal.
Third and fourth stage
In these stages, the tumor has progressed beyond the abdominal lymph nodes. The treatment for seminoma, and for non-seminoma tumors it is entirely with aggressive chemotherapy. After that, the response is carefully monitored with regular CT scans and tumor markers. Treatment of residual formations follows the principles, described under Stadius 2.
If the cancer is a recurrence of previous testicular cancer, treatment usually involves chemotherapy, sometimes followed by a bone marrow or stem cell transplant. The relapses, occurring more than two years after initial treatment, are usually treated surgically.