Testicular cancer - symptoms, causes, treatment and prevention

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What are testicles?

The testicles are the male sex organs, whose task is to produce sperm, i.e. male reproductive cells, and to produce testosterone - the male sex hormone.

The testicles are located outside the body cavity, in the so-called scrotum, because too high temperature impairs sperm production and can lead to infertility and increase the risk of developing cancer.

The descent of the testes into the scrotum takes place in utero, around the 28th week of pregnancy. Failure to do so is called cryptorchidism.

Types of testicular cancer

Testicular cancer can arise from all tissues of the testicle, but germ cell tumors are the most common. It is characterized by a dynamic course and a fairly rapid occurrence of metastases. Its formation is the result of abnormal transformation of cells from which sperm are normally formed.

Germ cell tumor can take one of two forms, differing in structure and course of the disease. Determining the type of cancer affects the choice of treatment method.

The two main groups of testicular germ cell tumors are:

• seminomas, they constitute 25-50 percent. of all testicular cancers and is more common in men aged 25-45
• non-seminomas, which constitute 50-75 percent. cases of testicular cancer and are more common in men aged 15-30 years

A characteristic feature of non-seminomas of the testis is that one tumor may contain elements of one or more subtypes of this tumor. The group of non-seminomas also includes seminomas accompanied by cells of another type of testicular germ cell tumor.

Testicular cancer - symptoms

The first symptoms of cancer may include thickening, changes in the size of the testicle, pain when touched, a feeling of pulling or discomfort in the scrotum.

The most important symptom is a painless lump in the testicle.

Other symptoms that may indicate cancer include:

• induration,
• swelling,
• a feeling of heaviness, pressure or discomfort in the testicle.

7 percent men develop gynecomastia, i.e. bilateral breast enlargement and tenderness.

Contact your doctor if:

- you feel any thickening or lump on the surface of your testicle

- you will notice changes in the size of the testicle

- you will notice pain in the testicle when lightly touched

- you feel discomfort or pulling in your scrotum or groin.

Metastases in testicular cancer

In advanced stages, symptoms associated with the presence of metastases include:

• abdominal pain,
• back pain,
• cough,
• shortness of breath,
• hemoptysis,
• paresis.

Causes of testicular cancer

Factors that contribute to the development of testicular cancer include:

• cryptorchidism, i.e. failure of the testicle or testicles to descend into the scrotum (this should occur around the 28th week of fetal life) - the risk of developing testicular cancer increases 5 times
• cancer of the second testicle - the risk of developing cancer of the second testicle is about 5%.
• genetic predisposition, such as testicular cancer in the family - especially in the father or brother
• Klinefertel syndrome¹ and some other inborn genetic defects, such as androgen insensitivity syndrome
• Caucasian race – Caucasian men are affected four times more often than black men

Testicular injuries are often mentioned, incorrectly, as a risk factor for the development of cancer, but scientific research does not confirm this theory. It turns out that the injury only draws the man's attention to the already existing tumor in the testicle.

Statistics show that testicular cancer is more common in infertile men. For now, medicine cannot explain why this is happening, but scientists suspect that both cryptorchidism, infertility and testicular cancer have common causative factors.

Testicular cancer diagnosis

Testicular self-examination

Testicular self-examination plays the most important role in early diagnosis. By performing a self-check every month according to the scheme, a man can observe any change in the appearance of the testicle and go with it to a urologist for further examination.

If testicular cancer is suspected, biopsy for histopathological examination should not be performed, as it increases the risk of dissemination of the disease.

During the diagnosis of suspicious changes in the testicle, the following tests are performed:

• Testicular ultrasound
• A blood test that assesses the concentration of biological tumor markers2 typical of testicular cancer. Their concentration is increased in about 80 percent. testicular cancers. These markers are:
• βhCG, or human chorionic gonadotropin beta - this is the same hormone that appears in women in early pregnancy and its concentration is tested in pregnancy tests.
• AFP, or α-fetoprotein.
• LDH, or lactate dehydrogenase.

In the case of the disease, markers play an important role in assessing the severity and prognosis of the patient. In addition, tumor markers are essential in determining the right treatment, in monitoring the patient's condition after treatment, as well as in detecting relapses.

Diagnostic extension is:

• computed tomography of the chest,
• computed tomography of the abdomen and pelvis.

Exceptionally, a chest X-ray may be performed instead of a CT scan.

In some cases, it is also performed:

• computed tomography of the brain,
• magnetic resonance of the brain,
• bone scintigraphy.

The results of these tests allow doctors to determine whether metastases are present and assess the severity of the disease.

Patients should also undergo hormonal and fertility tests, i.e. the assessment of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels.

Treatment of testicular cancer

Treatment includes surgery to remove the tumor with lymph nodes, chemotherapy and radiotherapy. Often these methods are also combined, which is called combination therapy. Your treatment plan depends on:

• type of cancer (seminoma or non-seminoma),
• advancement of the disease,
• negotiations.

Kernel removal

The first stage, implemented regardless of the stage of the cancer, is the total removal of the testicle, called orchidectomy. After excision, the testicle is examined under a microscope (histopathological examination), which allows to determine the type of cancer and to plan further treatment.

It is possible to implant a testicle prosthesis in the place of the removed testicle.

Most often, after surgery, the patient undergoes further treatment - chemotherapy and/or radiotherapy.

In patients with non-seminoma of the testicle, after completion of chemotherapy and normalization of marker levels, persistent tumors (so-called residual lesions) from the abdominal cavity and lesions from other places, e.g. lung metastases, are surgically removed.

In patients with testicular seminoma, surgery to remove persistent lymph nodes from the abdominal cavity after treatment is performed in the case of large lesions.

Because the treatment of testicular cancer may negatively affect fertility and the cancer tends to be bilateral, the patient should consider depositing his sperm in a special bank.

Prognosis and complications of testicular cancer

The course of testicular cancer is rapid - it quickly metastasizes to nearby lymph nodes.

Other places where testicular cancer can metastasize include:

• lungs,
• liver,
• bones,
• brain.

At the same time, this cancer is quite well treated and, if detected early, gives a good chance of a full cure.

This cancer is prone to recurrence and increases the risk of cancer in the other testicle. Therefore, after treatment, you should follow your doctor's instructions, attend check-ups and perform a self-examination of the other testicle every month.

Prevention of testicular cancer

The most important part of preventing testicular cancer is self-examination of the testicles. It should be carried out every month, and with all disturbing symptoms, consult a doctor.

Testicular self-examination is particularly important in young men under 30, who are most at risk of an unfavorable course of the cancer.