The testicle consists of many membranes, which are formed by various tissues. Tumors can arise from each tissue presented, this explains the variety of malignant testicular tumors. There is a classification of testicular tumors, which includes three sections – germ cell tumors, tumors of the gonadal stroma and other tumors. The most common germ cell tumors (seminoma, embryonic carcinoma, choriocarcinoma, yolk sac tumor, teratoma, mixed tumors), which are formed from the ducts, through which spermatozoa come from the cells in which they are formed, into the vas deferens, which carry sperm to the urethra. Seminoma is the most common germ cell tumor. It is this tumor that most often occurs and it is to it that the main attention will be paid further.
How common is testicular cancer and what predisposes to its development?
Testicular cancer most often occurs in men between the ages of 15 and 40. There are three peaks in the incidence of testicular cancer: before 10 years of age, at 20–40 years of age, and after 60 years of age. Testicular cancer accounts for approximately 2% of all neoplasms in men. This is one of the “youngest” tumors.
Cryptorchidism is a condition when, during fetal development or the first months of life, the testicle does not descend into the scrotum, remaining in the abdominal cavity or in the inguinal canal.
With cryptorchidism, cancer occurs 10 times more often in patients with undescended testicles. The highest risk of developing cancer in patients with intra-abdominal (inside the abdominal cavity) located testicles.
In 20% of cases, patients with unilateral cryptorchidism develop cancer in a descended testicle.
If both testicles are located in the intra-abdominal cavity, then the risk of developing cancer is 30%.
The testicle or testicles remain in the abdominal cavity, where the temperature is 2–3 degrees higher than in the scrotum. Prolonged exposure to elevated temperatures can lead to mutations, which in turn can lead to cancer. As reported in various scientific studies, cryptorchidism increases the chances of developing testicular cancer by 3-14 times. Heredity plays a role, but the genes that determine the development of testicular cancer have not yet been identified. Some time ago, there was an opinion that testicular cancer can be triggered by trauma. However, most experts believe that trauma is the reason for the patient to see a doctor and diagnose an existing tumor.
The first symptom that most often makes a man see a doctor is the presence of a neoplasm in the scrotum. Neoplasm is detected, as a rule, by chance. Unfortunately, regular self-examination of the scrotum is not promoted in Ukraine as a method of early detection of cancer. In general, little is said about testicular cancer and little is written in the media. A nodule or small swelling found by a man is usually painless. One third of patients have pain.
In about 10 percent of cases, the first manifestations are associated with the appearance of distant metastases. So, with testicular tumors, metastases can appear in the retroperitoneal lymph nodes, compress the ureters and disrupt the outflow of urine, which in turn can exacerbate pyelonephritis or lead to hydronephrosis. Metastases can appear in the lymph nodes of the neck, where they compress the upper respiratory tract, which in turn leads to shortness of breath, cough. Testicular tumors metastasize to the brain, causing mental changes, neurological disorders (paresis, paralysis). Testicular tumors metastasize to the lungs, disrupting respiratory function. With metastases of testicular tumors in the bone, pain and fractures occur.
Diagnosis of testicular tumors is based on clinical data – examination of the patient, examination and palpation of the scrotum, as well as examination and palpation of possible areas of tumor metastasis. An ultrasound examination of the abdominal organs is carried out, in which the presence of metastases in the internal organs, as well as the lymph nodes of the retroperitoneal space, is excluded or confirmed. An ultrasound examination of the testicle itself is also carried out, which makes it possible not often to determine the relationship of the tumor with other formations of the scrotum. X-rays of the lungs are taken to rule out or confirm the presence of lung metastases.
In the diagnosis of testicular tumors, a blood test is also used for specific tumor markers – protein substances that are detected during tumor development. So, a blood test is used for alpha-fetoprotein (AFP), the beta subunit of chorionic gonadotropin, lactate dehydrogenase. Elevated levels of these substances in the blood indicate the likely presence of testicular cancer. The same tests are used after treatment to control the tumor, as well as timely detection of recurrence.
Treatment of testicular tumors depends primarily on the stage. So, with seminomas of the first stage (without spreading to the lymph nodes), the testicle is removed and the retroperitoneal and iliac lymph nodes are irradiated. This treatment achieves a 5-year survival rate of 95 percent (95 percent of treated patients survive more than 5 years). In the second stage (with damage to the lymph nodes, but with metastases to the lymph nodes no larger than 5 cm), the affected testicle is also removed and the retroperitoneal and iliac lymph nodes are irradiated. The five-year survival rate in this case is 90 percent.
The third stage of the disease requires not only surgical and radiation treatment, but also the use of chemotherapy, which necessarily includes cisplatin. In 90 percent of cases, a 5-year survival is achieved. Stage 4 testicular cancer also requires combination therapy, which can be successful.
For nonseminoma tumors of the testicle, treatment also includes surgery – orchiectomy (removal of the testicle). If the lymph nodes are affected, chemotherapy is required, as well as surgery, which involves the removal of retroperitoneal lymph nodes.
Testicular tumors can be benign or malignant. Only an oncologist has the right to diagnose testicular cancer. Regular (monthly) self-examination and immediate medical attention if one of these signs is found can prevent the development of a malignant tumor, and if it is detected in a timely manner, a complete cure can be achieved.
Stand in front of a mirror. Examine the scrotum. If on the skin of the scrotum there are areas of redness and an increase in the size of the contents of the testicle.
Take the scrotum in your hands. Support the testicle with four fingers, and gently and slowly feel the testicle with your thumb.
Then try to feel the epididymis – a thin tube, elastic in nature.
You will need to see a doctor if:
- if you find an increase in one of the testicles;
- the study is painful;
- if you feel a tubercle that you have not felt before;
- if you have a feeling of “heaviness” in the scrotum.
- with the appearance of constant pain in the lower abdomen, in the groin area;
- when blood appears in the urine;
- with breast enlargement.