Testicular cancer is one of the most curable cancers, with a cure rate approaching 100% (less than 1% mortality). Testicular cancer is also a relatively rare cancer, but it is the most common form of cancer in young men and adolescents, between puberty and the age of 45, the average age of diagnosis being 37. In the United States, about 9500 men are diagnosed each year with the disease, with a 5-year survival rate of 95% according to the National Cancer Institute.

Testicular cancers are classified into two main categories: seminomas and “non-seminomas” (which include all the other forms). Seminomas are found more often in older men, while non-seminomas mostly affect young men. The only way to confirm the type of cancer is to have the testicle removed by surgery for analysis. This operation is called a total orchiectomy. It is done through an incision in the groin.

In almost all cases, only one testicle is affected. Very often, it is the discovery of a suspicious mass during palpation of the testicles that sounds the alarm. Testicular cancer is a cancer that responds well to treatment (95% of men heal). However, treatments, whether by surgery, radiotherapy or chemotherapy, carry risks of infertility.

When to talk to your doctor

If you notice a lump or swelling, usually painless and gradually growing in one of your testicles, you should go see you doctor. A small percentage of testicular cancers are likely to cause pain early in the course of the disease. Benign testicular tumors are rare hence the necessity to see a specialist quickly.

Symptoms of testicular cancer

The first symptom perceived is the increase in size of a testicle, sometimes manifested by a hard mass located in the bursae. In addition to this, the person affected may experience discomfort or pain in the affected testicle.

Symptoms vary from person to person but usually include a subset of the following conditions:

• A lump in a testicle;
• A feeling of discomfort or heaviness in the scrotum
• The appearance of fluid in the bursa;
• Pain in the bursae;
• Swelling and tenderness of the breasts;
• Infertility;

Risk factors

Certain factors increase the risk of testicular cancer.

• people who have had an undescended testicle in childhood (ectopic testis or cryptorchidism) where the testicle stays in the belly instead of descending normally into the bursa. The risk of testicular cancer is multiplied by 35. The operation to lower the testicle into the bursa does not fully protect against the risk of cancer.
• A decrease in the size of the testicle, for example after mumps (testicular atrophy), or after trauma increases the risk of testicular cancer
• Men who are HIV positive have a higher risk of testicular cancer.
• Men who have had testicular cancer on one side have an increased risk of getting cancer on the other side. They should therefore regularly palpate the other testicle for screening.
• Presence of testicular cancer in the father or in a brother.
• Being between 15 and 35 years old.
• Endocrine disrupting chemical pollutants are suspected to be involved in the occurrence of testicular cancer.

Diagnosis

After interviewing the patient, the doctor will perform a touch examination of the testicles. If testicular cancer is suspected, he will perform an ultrasound examination of both testicles, which will produce an image of the inside of the testicles.

If a testicular tumor is detected during the examination, the testicle in question must be removed by a small intervention via a cut in the groin. The affected testicle is removed with the associated semen strand and blood vessels.

At the same time, a small tissue sample of the other unaffected testicle is often examined in order to rule out possible changes in the cells (precursor cells of a testicular tumor), which can occur in about 5% of the affected persons.

Further examinations(X-ray examination of the lungs, computer tomography of the chest, abdominal cavity and pelvis) must be carried out to determine whether tumor cells have already been removed in order to ensure optimal treatment.

In addition, blood testing is used to determine so-called tumor markers, these are special proteins which play a role in the course and aftercare of the disease (e.g. alpha-fetoprotein (AFP) and placental-alkaline phosphatase (PLAP), lactate dehydrogenase (LDH) and human chorionic gonadotropin (HCG).

Through the examinations carried out, the doctor receives important information about the type and spread of the testicular tumor in order to create a treatment plan corresponding to the disease.

Prevention of testicular cancer

Since we do not know enough preventable causes for testicular cancer, we cannot give measures that would prevent it from occurring. On the other hand, it is recommended to carry out monthly self-examination of the testes throughout life, especially in young boys with a testicle that has not descended spontaneously, in boys or men with an abnormally small testicle, in HIV positive men because they are at high risk and more generally in all young men. Because the sooner testicular cancer is discovered, the better the chances of a cure with the fewest possible consequences.

Treatment of testicular cancer

The treatment of testicular cancer is primarily surgical. As soon as the diagnosis of testicular cancer is made, it is necessary to intervene quickly with surgery and to perform an orchiectomy (removal of the diseased testicle) by an inguinal approach (incision in the groin).

Then, the testicle containing the tumor is analyzed in the laboratory. Anatomopathological examinations make it possible to diagnose the histological type of the tumor, and to set up patient monitoring.

In young men, if they wish, a prosthesis can be placed in place of the missing testicle.

When the tumor is small and non-invasive, treatment may stop with surgery with intensive monitoring for the first few years.

Chemotherapy or preventive or curative radiotherapy is used sometimes depending on the results of the laboratory analysis of the tumor. The presence or absence of metastases determines the postoperative treatment protocol.

The early forms of testicular cancer have an excellent prognosis, and the therapeutic sequelae are low. Of course, a risk of tumor revival or extension is possible, but the prognosis remains good because these cancer cells are very sensitive to chemotherapy and radiotherapy.

Nonetheless, monitoring the patient for several years is essential after the treatments. After treatment, monitoring of serum markers (by regular blood tests) is very important. If they do not decrease after excisional surgery or if they increase after a period of normalization, the presence of metastasis or resumption of tumor development should be suspected.

It is suggested that patients with testicular cancer take semen samples for their conservation in the event of possible sterility secondary to treatment.

In conclusion

Testicular cancer is treated successfully in over 95% of cases when it is localized to the testicle. It must therefore be detected as quickly as possible, hence the importance of teaching young men to self-test the testicles. The side effects of these treatments are generally temporary, but require conservation of the sperm in case of consequences on fertility.

Careful monitoring after testicular removal is increasingly practiced today, but it requires excellent adherence to follow-up. if you are affected, you must therefore respect your appointments, which are fairly frequent during the first two years.