Testicular cancer

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 presents a cure rate of about 90%.

How is it produced?

There are no clear risk factors for testicular tumors. It should be said that the fact of presenting one from the abdominal cavity to the scrotum can lead to an increased risk of suffering from 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 remove them to prevent the development 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 it is possible to differentiate two large groups with different therapeutic implications:

• 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 they derive from cells of the supportive tissue of the testis, or they are lymphomas or metastases from other primary tumors.

Symptoms

The main and sometimes only symptom of a testicular tumor is usually the existence of a scrotal mass, unilateral and painless, which 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 an enlarged scrotum and signs of inflammation like redness of the skin and an increase in the temperature of the area. However, the main causes of an acute scrotum are orchitis and testicular torsions.

Diagnosis

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 an overall increase in testicular size no 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 allow delineate the borders and size of the tumor, as well as 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.

Treatment

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, a lymph node removal in advanced stages and sometimes chemotherapy will need to be given. In advanced cases, both seminoma and non-seminoma tumors, the intervention will be performed and then, if there are remains, another round of chemotherapy can be done.

In less severe cases, without lymph node involvement, the patient tends to be monitored and how he evolves to try to avoid, as far 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 a intrascrotal prosthesis to supply the gonad excised.

Precautionary measures

There are no preventive measures other than the fact of lowering the undescended intra-abdominal testes in childhood or removing undescended intra-abdominal testes in adolescence.