Testicular cancer is one of those that most worries the male population. Discover all the details of this disease: symptoms, causes, prevention and more.
What is it?
Testicular cancer is not a very common tumor, it affects only 1-2% of the male population, with a higher incidence between 15 and 35 years of age, being the most frequent neoplastic disease in men between these ages after leukemias. Thanks to new advances in both diagnosis and treatment, testicular cancer has a cure rate of approximately 90%.
How is it produced?
There are no clear risk factors for testicular tumors. It should be noted that the fact of presenting an undescended testicle from the abdominal cavity to the scrotum can lead to an increased risk of developing a testicular tumor. It is recommended to lower them before two years of age. If you reach adolescence and have not descended, it would be advisable to remove them to avoid the appearance of testicular tumors. Other risk factors can be inguinal hernias or radiation exposure.
It is important to note that there are different types of testicular tumors depending on the cells that form them. 95% of testicular tumors derive from germ cells, that is, from the cells that give rise to mature sperm. Within these tumors, two large groups with different therapeutic implications can be distinguished:
- Seminomas, which are the most common type of testicular tumor and which present a high response to radiotherapy.
- No seminomas, teratocarcinoma and embryonal carcinoma being the second and third most frequent types of testicular tumor, respectively. Other non-seminoma tumors include endodermal sinus tumor, choriocarcinoma, or teratoma.
The remaining 5% of testicular tumors are derived from supporting tissue cells of the testis, or are lymphomas or metastases from other primary tumors.
The main and sometimes only symptom of a testicular tumor is usually the existence of a scrotal mass, unilateral and painless, that increases in size progressively. Other much less frequent symptoms are the appearance of inguinal lymphadenopathy, the presence of gynecomastia or, in the case of children, the appearance of physical signs of precocious puberty.
10% of tumors can present as what is known as an acute scrotum, that is, the sudden appearance of intense pain at the scrotal level with an increase in its size and signs of inflammation such as redness of the skin and increased the temperature of the area. However, the main causes of an acute scrotum are orchitis and testicular torsions.
A testicular tumor should be suspected in any patient who explains the appearance of a testicular mass. The initial diagnosis will be based on the physical examination, palpating a unilateral testicular mass or a global increase in testicular size without pain on palpation or other associated symptoms, such as discomfort when urinating or fever.
A blood test is essential to assess two hormones that are usually elevated, alpha-fetoprotein (AFP) and human chorionic beta-gonadotrophin (βHCG). AFP is elevated in 70% of non-seminoma tumors, while it is never elevated in seminomas. ΒHCG is elevated in 70% of non-seminoma tumors and in 5% of seminomas.
Performing an ultrasound will make it possible to delineate the borders and size of the tumor, as well as to differentiate it from cystic lesions. The extension study will be carried out by means of a thoracoabdominal computerized axial tomography (CT). It is a tumor that rarely spreads through the blood except in the case of choriocarcionoma.
The treatment will be different depending on the type of tumor and the degree of extension. In all cases, it is necessary to remove the affected testicle (orchiectomy). In seminomas, subsequent radiotherapy will be performed in case of lymph node involvement, while in non-seminomas, in addition to orchiectomy, lymph node removal will be performed in advanced stages, and chemotherapy will sometimes be administered. In advanced cases, both seminoma and non-seminoma tumors, chemotherapy will be performed prior to the intervention and then, if there are remains, another round of chemotherapy can be done.
In less severe cases, without lymph node involvement, there is a tendency to monitor the patient and see how he evolves to try to avoid as much as possible radiation therapy in the case of seminomas or lymphadenectomy or chemotherapy in the case of tumors no seminomas.
The 10-year survival of seminomas is 80-95%, while that of non-seminoma tumors is 90-100%.
In many cases and for aesthetic reasons, an intrascrotal prosthesis can be placed to replace the excised gonad.
There are no preventive measures except for the fact of lowering the undescended intra-abdominal testes in childhood or removing in adolescence.