Testicular Cancer

"After treatment for testicular cancer, it is very important to have regular check-ups".

DR. FERNANDO DÍEZ-CABALLERO ALONSO
SPECIALIST. UROLOGY DEPARTMENT

Testicular cancer originates in over 90% of cases in the testicular cells called germ cells, which produce sperm. The main types of germ cell tumors in the testicles are seminomas and nonseminomas.

The causes of testicular cancer are unknown as well as the risk factors that may favor the appearance of this type of tumor:

The main risk factor is the lack of descent of the testicle at birth (cryptorchidism).

Other factors that have been associated are high concentrations of maternal hormones during pregnancy and premature birth, trauma to the testicle and the presence of a family history of testicular cancer.

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What are the symptoms of testicular cancer?

The vast majority of testicular tumors are diagnosed by the appearance of a lump in the testicle, which is often painless. In cases where there is pain, it usually appears progressively, although it may appear suddenly if the tumor is complicated by infection (orchiepididymitis) or if it bleeds.

Breast growth may appear in males due to an increase in Beta-Gonadotropin Chorionic, a hormone that only increases in males in some cases of testicular tumors.

In some patients there may be back or abdominal pain, caused because the painful stimuli of the testicle are directed to that place or because there are metastases in lymph nodes in the retroperitoneum.

In cases where there are metastases in other organs (lung, brain, bone, etc.), these can produce very varied symptoms, depending on their location.

The most common symptoms are:       

  • Bultoma in testicle.
  • Pain.
  • Increase in the size of the breasts.

Do you have any of these symptoms?

You may have testicular cancer

What are the types?

There are two main types that are important to differentiate since the treatment scheme will be different:

  • Seminoma: these are tumors that should not be mixed with other tumor types, they are 40% of testicular tumors and are more frequent during the fourth decade of life. These tumors are more sensitive to radiotherapy than other testicular tumors.
  • Nonseminoma: Nonseminomatous tumors account for 60% of testicular cancers and usually appear during the third decade of life.

What are the stages?

  • Stage I: the tumor only affects the testicle.
  • Stage II: the tumor spreads to lymph nodes, usually located in the retroperitoneum (the area behind the abdomen). There are no metastases.
  • Stage III: the tumor has metastases or very significant elevation of tumor markers.

How is testicular cancer diagnosed?

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The diagnosis of testicular cancer will be made by a detailed clinical history and a physical examination by a specialist.

If a mass is detected on palpation, it will be necessary to perform a blood test (with detection of alpha-fetoprotein and beta-HCG, tumor markers that are elevated in these patients) as well as a testicular ultrasound to determine the characteristics of the tumor and to know if the other testicle is affected.

The study should be completed with additional imaging tests: abdominal CT, bone scintigraphy and PET, to evaluate whether the tumor affects neighboring structures or has even spread to a distance. 

How is testicular cancer treated?

Treatment will depend on the type of tumor the patient has and the stage of the tumor.

The initial treatment will always be surgical, even when the cancer has spread, surgical removal of the testicle is also indicated.

This treatment can be complemented with adjuvant chemotherapy and/or radiotherapy to slow progression and prevent relapse. The chemotherapy drug used is carboplatin, which is reasonably tolerated and very effective in this type of tumor. 

In the check-ups, in addition to the collection of symptoms and physical examination, a determination of tumor markers is usually performed.

In addition, a chest X-ray, abdominal CT scan and testicular ultrasound are usually performed periodically.

The frequency of check-ups is usually variable and their duration should be lifelong, since there is a small risk of developing tumors in the healthy testicle.

Where do we treat it?

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