st lukes website

What is testicular cancer?

‍

Testicular cancer is malignant neoplasia in the tissues of the testicles. It is a relatively rare type of cancer, accounting for 1.5% of cancers in men. However, it is one of the most common types of cancer in younger people. It occurs most often in men aged 15 to 35 years. If detected in time, the cure rate is up to 95%. But even if there is metastasis, the cure rates are still high. In addition, patients can usually maintain their sexual and reproductive capacity.

‍

What are the types of testicular cancer?

‍

There are two types of testicular cancer, depending on the type of cells they come from:

‍

Semenomatous

‍

It originates from germ cells and usually occurs between the ages of 30 and 40. It develops slowly and metastasises more slowly and less frequently than the other types.

‍

Non-seminomatous

‍

Non-seminomatous tumours, or stromal - genital band cancers, usually occur in younger people, with faster growth and spread than seminomatous cancers.

‍

Other forms of testicular cancers, such as sarcomas and lymphomas, are quite rare.

‍

What are the risk factors?

‍

‍

In most cases, it is not clear what causes testicular cancer. However, there are several factors that have been associated with its development. In particular:

‍

Age from 15 to 35 years old

‍

Race. White men are affected 4 times more often than men of color.

‍

Inheritance

‍

Genetic factors. Certain genes increase the risk of testicular malignancy.

‍

Microlithiasis of the testicles

‍

Background on cryptarchy. It is a condition in which one or both testicles have not descended into the scrotum. It is associated with an increased risk of testicular cancer, particularly when treatment is delayed.

‍

Infertility. Studies show that infertile men have a slightly increased risk of testicular cancer.

‍

AIDS infection

‍

Environmental - professional factors

‍

Klinefelter's syndrome

‍

Infant hernia

‍

What are the symptoms?

‍

‍

The most common symptoms of testicular cancer are:

‍

A lump on the testicle, which is usually painless

‍

Pain in the testicles and/or abdominal pain

‍

Enlargement or swelling of the testicle

‍

Feeling of weight in the scrotum

‍

Enlargement and sensitivity of the breasts

‍

Symptoms due to metastases

‍

In several patients (30%), the main symptoms come from metastases. Seminomas give lymph node metastases, usually some time after their appearance. Later, haematogenous dissemination to the lungs, liver, bones, brain, etc. occurs. In contrast, non-seminomatous tumours (with the exception of choriocarcinoma) give early lymph node metastases, which precede haematogenous dissemination.

The most common primary focus is on the prostate.

‍

The most common symptoms due to metastases are back pain from swollen retroperitoneal lymph nodes, cough and shortness of breath from metastases in the lungs, swelling in the epigastrium, neck pain, nausea, vomiting and weakness.

‍

How is the diagnosis made?

‍

Palpation of the testicles

‍

Testicular ultrasound

‍

Blood tests - cancer markers (AFP, beta-hCG, LDH, PLAP). There are cases where the values of cancer markers are at normal levels.

‍

Staging (extent and spread of the disease)

‍

If the existence of testicular cancer is confirmed, additional tests should be done to assess the extent of the problem and any metastases. These tests are:

‍

Chest X-ray and/or CT scan of the chest

‍

Abdominal CT scan

‍

Bone scintigraphy

‍

Brain scan

‍

What is the treatment?

‍

The treatment of testicular cancer is mainly surgical, but it may be accompanied by chemotherapy or radiotherapy, depending on the type and stage of the disease.

‍

Surgery

‍

Surgery is recommended in all cases, regardless of stage, classification or metastases. A high orchiectomy is performed.

‍

Chemotherapy

‍

The duration and type of treatment programme depends on the type and stage of the cancer. Chemotherapies for testicular cancer are not strong and rarely have side effects. Many times chemotherapy cycles are done as a preventive measure, especially for dangerous types of cancer.

Radiotherapy

‍

Follow-up after treatment

‍

Follow-up is required for at least 5 years after a successful treatment. To detect any relapse, the following tests are performed:

‍

Examination of cancer markers

‍

Chest X-ray

‍

Abdominal CT scan

‍

What is the prognosis?

‍

The prognosis is usually very good. Thanks to advanced drugs, testicular cancer has a cure rate of over 95%. In fact, if diagnosed and treated at an early stage, cure is a given. But even if the cancer has spread, there is still a very high chance of cure.

‍

What happens to fertility?

‍

Removing one testicle, even if the other is normal, does not affect the sex life. Fertility, however, can be adversely affected. This possibility increases if the patient undergoes additional chemotherapy or radiation. For this reason, sperm freezing is recommended. Also, for two years after chemotherapy, pregnancy should not occur, because the risk of teratogenesis increases.

‍

In 50% of patients, fertility returns to normal after two years of chemotherapy/radiotherapy. The percentage increases after five years. Unfortunately, 20% of cases will remain permanently infertile.

‍

Is there any prevention?

‍

The best prevention is self-examination (palpation) of the testicles . This procedure is done by the person and is recommended once a month.

Men with a family history or a history of cryptorchidism should be monitored annually by ultrasound after the age of 16 years.

‍

‍

How is the testicular self-examination done?

‍

This examination takes only a few minutes. The best time for the self-examination is immediately after a hot bath, because the skin of the scrotum is looser and the testicles are easier to feel. Each testicle is examined individually and in comparison to the other. The man places his thumbs on the anterior surface of the testicle, supporting it with the index and middle fingers of both hands. Each testicle is gently rotated between the fingers and thumbs and carefully checked for lumps, hardness or thickness, compared to the other testicle. The urologist should be informed when hard masses or changes in the shape, size and composition of the testicles are detected.

‍

References

‍

https://www.andrologos-ourologos.gr/καρκίνος-όρχεων/

https://www.katsivas-urology.gr/karkinos-orxeon/

https://ploumidisurology.gr/services/kakoithia-orxeis/

https://www.onmed.gr/ygeia/story/333936/karkinos-ton-orxeon-ta-proeidopoiitika-symptomata

https://www.bestrong.org.gr/el/cancer/typesofcancer/testicularcancer/

https://www.mayoclinic.org/diseases-conditions/testicular-cancer-care/symptoms-causes/syc-20352986

https://www.nhs.uk/conditions/testicular-cancer/

https://my.clevelandclinic.org/health/diseases/12183-testicular-cancer

https://www.cancer.org/cancer/testicular-cancer/about/what-is-testicular-cancer.html