Testicular cancer: causes, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Jun 20, 2023

Testicular cancer, or testicular cancer, is a neoplasm that originates from cells of the male gonads, both germinal and non-germinal

The origin of this process is not easy to identify, but clinical studies have highlighted factors or conditions that increase the risk, such as cryptorchidism, a family history of neoplastic diseases, infertility, cigarette smoking and tall stature .

This neoplastic process appears as a small swelling in the testicles, roughly like a chickpea, and sometimes with scrotal pain.

If it is diagnosed early, the chances of recovery are very high thanks to surgery, chemo and – in the most serious cases – radiotherapy.

What is testicular cancer?

Testicular cancer is not a very common malignancy and can be located in one or both male gonads or testicles.

Testicular tumors can be of different types, depending on the cells from which they originate.

If the tumor originates in germ cells (i.e. those that produce sperm) we can talk about:

Seminomas: neoplasms with the most favorable course. Germ cells have an uncontrolled growth that leads to a malignant transformation and are the most frequent tumors in men between 40 and 50 years of age. It is possible that they also involve some non-seminal cells in the process, in this case we can speak of mixed germinal forms.
Nonseminomas: These can include various forms of cancer, such as embryonic carcinomas, yolk sac tumors, teratomas, and choriocarcinomas.
Testicular tumors that originate in non-germ or stromal cells and are about 5% of the total. These include Sertoli cell tumor and Leydig cell tumor.

Testicular cancer is a disease that affects 1% of all cancers affecting men and represents 3-10% of cancers affecting the male urogenital system.

It usually develops between the ages of 15 and 44, particularly in Caucasians.

Although the frequency of this neoplasm has increased – inexplicably – dramatically in recent years, the mortality rate has clearly decreased thanks to the great advances in its treatment.

If diagnosed promptly, testicular cancer responds well to treatment.

Although it tends to affect only one gonad, it is possible that a man who has suffered from tumor in one testicle could later develop it in the other as well.

What are the causes?

As often happens, the causes that lead to the development of this neoplasm are not yet fully understood.

However, there are some factors that increase the risk, such as Klinefelter’s syndrome and other pathologies involving abnormal development of the testicle, infertility and the presence of other neoplasms in the family.

Cryptorchidism – i.e. the failure of one or two testicles to descend into the scrotum – can also contribute to the development of the neoplasm, but also the habit of cigarette smoking and tall stature.

Symptoms and complications

The first sign that indicates the possible formation of the tumor is a hard lump that is not painful to palpation of the testicles.

The dimensions vary, it can be as small as a seed or the size of a tangerine, although in most cases it is more or less the size of a chickpea.

Although it is not the origin of the pain, in some cases the presence of the mass may be associated with pain symptoms radiating to the entire scrotum and an increase in the volume of the testicle, which could be caused by an inflammatory intratumor edema.

There are also other symptoms which, although they are not peculiar to the tumor, should not be overlooked, and they are:

testicular shrinkage,
Presence of blood in urine and semen,
Pain in the lower abdomen,
Gynecomastia, or breast tissue enlargement in men.

Although all the symptoms described, including the formation of a small mass, are important signs of the possible presence of the tumour, it is advisable to promptly contact the general practitioner when one or more signs appear: in the case of neoplasia, in fact, the more timely diagnosis, the sooner it is possible to intervene and the more likely it is that the therapies will lead to a good outcome.

Although the chances of recovery are high, it should not be underestimated at all: a testicular neoplasm – if it originates from certain tissues or is not treated properly – can produce metastases, spreading to other parts of the body.

Through the lymphatic or blood system it can reach the lymph nodes (first close and then far away) or in the most important organs such as the liver and lungs.

For this reason it would be good to perform a periodic self-examination of the scrotum in search of any anomalies, in order to intervene as soon as possible.

Testicular cancer diagnosis

Once you have identified these symptoms, it is advisable to contact your doctor.

Initially you will be asked a few questions to identify any risk factors and symptoms related to testicular cancer.

We will then move on to the physical examination, during which the specialist will identify and observe the swelling through palpation.

At this point, the suspicion must be confirmed with diagnostic tests: first of all, a scrotal ultrasound must be performed which will allow us to establish whether we are dealing with a solid mass or a collection of liquids; a blood sample will have to be taken to determine tumor markers.

This term indicates those particular substances that the tumor releases into the blood.

This investigation methodology must be included in a well-defined diagnostic path, in fact, it is not certain that testicular cancer produces detectable markers in the bloodstream, it is therefore necessary to proceed with caution and integrate this test with others.

The substances that could be traced are AFP, HCG or LDH.

It will probably be necessary to perform a biopsy of the mass which will give definitive confirmation of the possible presence of testicular cancer.

A small portion of tissue from the testicle will have to be taken in order to be able to observe it under a microscope.

With this method, tumor cells are easily recognized.

If the doctor fears that metastatic processes have already occurred, he will prescribe various radiological checks: specifically, he will ask to carry out a chest X-ray, a CT scan or an MRI.

Obviously, the severity of the tumor can be variable and depends on the characteristics it possesses: in particular, the size of the mass and the diffusion capacity of the tumor cells are considered.

We find 4 stages:

Stage 1: when the tumor is limited to the affected testicle.

Stage 2: in this case the tumor affects the testicle and the lymph nodes near the scrotum (those in the abdomen and pelvic area).

Stage 3: The cancer has metastasized to the lymph nodes in the chest.

Stage 4: This is the most severe stage of the cancer. The metastasis process has affected not only the lymph nodes but also organs such as the lungs and liver.

Therefore, we understand the need for a timely diagnosis, which allows testicular cancer to be treated with excellent results: 90% of patients recover completely after surgery.

Furthermore, it is possible that with an early diagnosis only one cycle of chemotherapy – called surveillance – may be necessary, while in an advanced phase more cycles of chemotherapy may be necessary also associated with radiotherapy, with all the side effects of the case.

It has been found that 25-30% of recovered patients experience a relapse within two years of surgery.

For this reason, during this period of time, the doctor will establish a control therapeutic plan, with periodic diagnostic tests, first more frequent (generally every 3 months in the first year) then more spaced out over time (every 6 months in the second year). year and once a year starting from the third postoperative year).

Treatments to fight testicular cancer

The only way to permanently cure testicular cancer is surgery called orchidectomy, which is the removal of the affected testicle.

This operation is performed under general anesthesia: a small incision is made in the groin, such as to allow the testicle to come out.

If the patient requests it – mostly for aesthetic reasons – the surgeon can insert an artificial silicone prosthesis in place of the removed testicle.

Following the operation – depending on the severity of the tumor – it is possible that the decision is made to also remove the abdominal lymph nodes and it is necessary to perform one or more cycles of chemotherapy and, possibly, also cycles of radiotherapy.

In this way, in fact, it is possible to permanently eliminate cancer cells from the body.

The lymph node removal surgery does not present particular contraindications, although in some cases it may present a disorder known as retrograde ejaculation.

The situation is different for chemotherapy and radiotherapy.

Chemo consists of administering drugs capable of killing all rapidly reproducing cells, including cancer cells.

Radiation therapy, on the other hand, subjects the patient to several cycles of ionizing radiation that aim to destroy the tumor cells.

These treatments, while necessary, have many side effects, such as nausea, diarrhea, exhaustion, fatigue, hair loss and vulnerability to other infections.

In the event that the tumor is bilateral, both testicles will be removed: hormonal treatment will then be necessary to restore erection capacity but it will be impossible to restore fertility.

However, in the case of removal of a single testicle, the patient’s libido and fertility remain unchanged.

Prevention

There are no effective prevention techniques for testicular cancer but it can be treated promptly: this is made possible thanks to self-examination to check for any anomalies.

Obviously, particular attention must be paid to those men who present the risk factors illustrated above.

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