Testicular cancer
Testicular cancer: Description
Testicular cancer is a malignant tumor of the testes, which is relatively rare compared with other cancers yet is treatable. Younger men between 20 to 40 years of age are in particular affected by this disease. Testicular cancers are differentiated by their tissue types: those consisting of germ cells are divided into seminomatous (also: germinomatous) and nonseminomatous (also: nongerminomatous) forms. These two are the most common forms of the disease, encompassing over 90% of those affected. Carcinomas composed of supporting and connective tissue of the testes can also emerge (e.g. Leydig cell tumors).
Testicular cancer: Symptoms
Testicular cancer usually causes no painful symptoms and rarely leads to dysfunction. However, if nodes or nodular growths or lumps can be felt on a testicle or in the scrotum, or if there is enlargement of a testicle, these are signs of a possible tumor. Any irregularity in the size and character of a testicle requires immediate medical evaluation.
Testicular cancer: Causes and Risks
No direct cause for the development of testicular cancer is yet known. However, a number of risk factors may promote the disease. An undescended testicle (maldescensus testis) is one of the most important factors. Also, there is an increased risk of germ cell tumors if a close relative was diagnosed with a testicular tumor.
Testicular cancer: Examination and Diagnosis
Those patients who check their testicles regularly can contribute to early detection of testicular cancer. Urological examination by a specialist begins with palpation of the testes and the abdomen. In case of a suspected tumor, sonography, magnetic resonance imaging (MRI) or computed tomography (CT) can be performed for further evaluation. A testicular biopsy is contraindicated in case of a possible testicular tumor, as this could lead to the spread of tumor cells. Therefore if there are clinically and sonographically strong grounds for suspicion, a scrotal exposure operation is always performed. Before therapeutic measures are employed, the patient's blood is taken to determine the tumor marker. Certain levels of enzymes and proteins circulating in the blood - alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), placental alkaline phosphatase (PLAP) and lactate dehydrogenase (LDH) - may be increased if there is testicular cancer.
Testicular cancer: Treatment
The most reliable method for the treatment of testicular cancer is an orchiectomy (also: ablatio testis) - surgical removal of the affected testicle. Although the patient's reproductive performance is not usually affected by the removal of a single testicle, it is still recommended that the person concerned have their testosterone levels measured and sperm cells preserved. After the procedure, depending on the stage of the tumor, chemotherapy, radiotherapy or a combination of these treatments are performed. In selected cases, the surgical removal of lymph node metastasis (retroperitoneal lymphadenectomy - RLA) in the rear abdominal cavity (retroperitoneum) can be useful . In any event, today the specific treatment of testicular cancer patients is usually decided by an interdisciplinary Tumor Board consisting of radiologists, urologists, radiatiotherapists and oncologists. This ensures that each patient receives their optimal therapy.
Testicular cancer: Course and Prognosis
With early detection of the disease, the prognosis for testicular cancer is generally good. The risk of metastasis is lower in seminomatous than nonseminomatous cases, which must usually be treated with additional chemotherapy.
After surgical removal of the testicle, the patient can receive a testicular prosthesis made of silicone. These prostheses are both optically and tactily difficult to distinguish from real testicles. Clinical problems with testicular prostheses are extremely rare.
Testicular cancer: Miscellaneous/Other Comments
Organ-preserving surgery - meaning the removal of only the testicular tumor and not the entire testicle - is only possible in special cases (e.g. bilateral testicular tumor or tumor in a single testis).
Before performing chemotherapy, cryopreservation should always be undertaken (freezing sperm in liquid nitrogen) because in some men permanent infertility can occur after chemotherapy.
If a testicular tumor precursor (testicular intraepithelial neoplasia - TIN) is detected, local radiation therapy can be conducted on the affected testicle. In this case, a total dose of 16 - 20 Gy is usually administered. This almost always results in permanent spermatogenesis damage in that testicle. Testosterone production is usually preserved. Men with a history of testicular cancer have a long-term statistically significant increased risk for the development of hypogonadism (testosterone deficiency syndrome). Patients should therefore be regularly examined for possible clinical symptoms, and their laboratory test results checked.