Testicular cancer (testicular carcinoma)

Testicular cancer is one of the most common malignant tumors in young men. Nevertheless, it is one of the cancers with the best chances of cure.

In general, testicular cancer is very rare. Statistically, it is one of the most common forms of cancer among tumors in men under 40 years of age. Approximately 4750 men are diagnosed with testicular cancer each year, while the average age of onset is 37 years.

It is not yet clear how testicular cancer occurs. However, an incomplete descent of the testis (maldescensus testis) is considered to be a risk factor.

One can distinguish between two groups of testicular cancer: the more common seminomas and the rarer non-seminomas, which in turn are subdivided into numerous subtypes. The difference lies in the fact that different cell types degenerate in seminomas and non-seminomas. Separating the two types is important because seminomas respond to radiation therapy, while non-seminomas can only be treated with surgery and chemotherapy.

It is not yet clear how testicular cancer develops. In general, however, there is an increased incidence of testicular cancer in men who had an undescended testicle (maldescendus testis) in childhood (even if this was corrected surgically), who suffer from infertility, underdeveloped testicles or a certain chromosomal anomaly (Klinefelter syndrome). An increased risk could also be established in the case of a hereditary predisposition, i.e. if the father or brother has already suffered from testicular cancer. In addition, it is assumed that a high estrogen level of the mother during pregnancy increases the risk of the disease in the unborn son.

Within the last decades the incidence of testicular cancer has increased. This is especially true for the age group of 35 to 49 years. The main causes are thought to be the use of pesticides and insecticides, the early onset of puberty, viral diseases, exposure to solvents, heavy metals and chromium. Nevertheless, none of these factors has yet been scientifically proven.

It is assumed that the development of cancer precursor cells already takes place prenatally in the embryonic phase. These so-called TIN cells (= testicular intraepithelial neoplasia) can later develop into testicular cancer cells under hormonal influence from puberty onwards.

Often, testicular cancer is only detected by chance. It is noticed by an enlarged, nodular change in the testicle, which is particularly noticeable in the side comparison. Additional symptoms can be pulling testicular pain, as well as a feeling of heaviness of the affected testicle. However, these features do not necessarily have to be present. Some testicular tumors tend to produce estrogens (female sex hormones). If this is the case, the mammary glands may swell (gynecomastia).

If there is a suspicion of testicular cancer, the doctor makes the diagnosis on the basis of a scanning examination of both testicles, as well as an ultrasound examination (sonography). The results of the ultrasound examination are very informative: it is almost always possible to determine whether the cause of the swelling lies in the testicle or in another structure of the scrotum. If the doctor suspects testicular cancer, he will first examine both groins, as there are lymph nodes there which may already be affected. In the groin area there may also be testicles that have not completely descended. In some cases, it is also necessary to take a tissue sample (biopsy) from the testicle in order to obtain a reliable diagnosis.

If the diagnosis of testicular cancer is confirmed, further examinations must be carried out to determine whether other organs have already been affected by tumour cells (metastases). To determine this, X-ray examinations and computer tomography of the chest, abdomen and pelvis are performed.

In addition, so-called tumour markers, which are produced by cancer cells, are determined in the blood. Alpha fetoproteins (AFP) and beta human chorionic gonadotropin (ß-HCG) are specific for testicular cancer. Although these values cannot be used to make a definite diagnosis, important conclusions can be drawn later about the course of treatment for testicular cancer.

If the diagnosis of testicular cancer is confirmed, the testicle with the associated spermatic cord and blood vessels is removed in the course of an operation. If the tumour accounts for less than 30 percent of the testicular volume, it may also be possible to perform an operation at special tumour centres in which the testicle is preserved. In most cases, a tissue sample about the size of a grain of rice is taken from the healthy testicle during surgery. This sample can be used to detect precursor cells of a testicular tumor. This allows the doctor to determine whether the second testicle is either healthy or already affected by cancer.

Depending on the microscopic diagnosis (seminoma or non-seminoma) and the spread of the tumor, it is up to the doctor to decide whether further measures may need to be taken. These include either radiation therapy, chemotherapy, surgical removal of the lymph nodes in the abdomen, or a combination of these methods. If the testicular cancer is already advanced, chemotherapy may need to be given first to limit the size of the tumor so that surgery can be done at a later time. Chemotherapy is most commonly used for metastatic testicular cancer.

Side effects can be expected depending on the type and extent of treatment. Removal of both testicles renders the man infertile. This can also happen with intensive chemotherapy and radiation therapy.

Follow-up care for testicular cancer involves regular monitoring of tumor markers in the blood. In addition, there are X-ray examinations of the chest and abdomen and ultrasound examinations of the healthy testicle. The purpose of these checks is to ensure that there are no more cancer cells in the body that could cause a tumour to grow again. In addition, the regular follow-up appointments should be attended over a period of three to five years.

If both testicles have been surgically removed or if there is a low testosterone level after treatment, this can be counteracted with lifelong testosterone administration.

In general, the prospects for recovery from testicular cancer are very good. Most patients recover completely. Five years after diagnosis, more than 95 percent of those affected are still alive.

However, the chances of cure depend on the extent to which the tumor has spread at the time of diagnosis. This mainly affects patients with non-seminomas, for whom the chances of cure decrease significantly as the disease progresses.

If possible, the treatment of testicular cancer should be carried out in a specialist clinic that works in a multidisciplinary manner.