Trauma, infections or radiation does not increase the incidence of testicular tumors
Testicular tumors are extremely chemo sensitive and respond excellently to treatment
Testicles are the male gonads (glands) which are responsible for secretion of the majority of androgenic hormones in men and sperm production.
Testicular cancer accounts for 1% of all cancer diagnoses in men. There are many types of testicular cancer and most develop from germ cells (germ cell tumors) or spermatocytes (testicular tumors). This depends on the cell type from which the tumor develops.
Etiology and classification
There has been a marked increase in the incidence of this pathology in black men compared to Caucasians and greater in Caucasians when compared to Asians. Cryptorchidism (failure or delay of the descent of the scrotum with the testicles remaining in the abdomen) is associated with an increased risk of developing a testicular tumor (a risk of 10 to 40 times greater). The risk of a bilateral cancer is much higher in cases of patients with feminizing syndromes. Suggested risk factors are: previous medical history of orchitis (inflammation of the testicle) and testicular trauma or irradiation. A clear cause-effect has not been defined in any case.
Seminoma and non-seminoma are the two main types of testicular cancer. Each of these is divided into histologic subtypes which will mark the progress of the disease (spermatocytic, choriocarcinoma, embryogenic, yolk sac tumor and teratoma). The first group is usually diagnosed between the ages of 20 and 30, and the second between the ages of 40 and 50.
A painful testicular mass is the most common symptom once benign pathologies (orchitis, epididymitis, hydrocele or varicocele) have been ruled out.
Although it is a very rare clinical presentation, breast augmentation can be seen in cases of B-HCG hormone-producing tumors. Other symptoms such as back pain, chest pain or headaches, come from metastatic involvement and will serve as a guide for a spread study.
Diagnosis should include determination of serum markers such as LDH, B-HCG (beta human chorionic gonadotropin) and alpha-fetoprotein. Their determination and follow up helps with tumor diagnosis, classification and monitoring although elevated levels will not be shown in all tumor types.
ITAcC experts recommend that image testing must be done in the study of patients with testicular cancer:
- Computed tomography (CT) is done of the abdomen and pelvis along with a CT or chest x-ray.
- PET-CT: it is not useful during initial diagnosis and may be necessary in the case of persistent lesions, provided it is not a non-seminoma tumor.
The use of other tests such as MRI or bone scan to determine or rule out other pathologies or from disease complications depends on the symptoms or signs affecting the patients at the time of initial diagnosis or during patient progress (treatment or follow-up).
Orchiectomy (inguinal removal of the affected testicle) is the main surgical procedure to be performed in these patients and is seen as a diagnostic procedure as well as the main treatment for localized cases at the testicular level (initial stages of the disease).
Testicular tumors are extremely chemosensitive and respond excellently to treatment. Adjuvant chemotherapy is necessary after an orchiectomy when risk factors of a tumor relapse have been identified by a histopathological study or if the levels of tumor markers do not normalize or if the disease has spread beyond the testicles.
Radiotherapy has been used also as adjuvant therapy in cases of localized disease at a testicular level, prophylactically in node chains and as a treatment to improve symptoms difficult to control with previous therapies.
At iTAcC we have the means to monitor and control the progress of patients who have had a testicular tumor in order to rule out the possibility of disease recurrence.
At iTAcC a follow up is done as in all oncological activity at our center in a personalized manner with the cooperation of physicians who have been involved in the diagnosis and treatment of each case.