Testicular Cancer Diagnosis and Treatment

Testicular Cancer

The testicles are the male organs responsible for sperm production and certain hormones. Although rare, testicular cancer is one of the most common cancers in young men. Cancer develops from an alteration of testicular cells, causing uncontrolled growth and the formation of a mass. Most testicular cancers originate in germ cells, which give rise to sperm.

Risk Factors for Testicular Cancer

Here are the main risk factors for developing testicular cancer:

• History of cryptorchidism: In these cases, the risk of developing testicular cancer is 10 to 40 times higher than in healthy men;
• Hereditary factor: Individuals with a first-degree relative with a history of testicular neoplasia are more likely to be affected than the general population;
• Estrogen use during pregnancy: According to some epidemiological studies, this may increase the predisposition to neoplasia in the unborn child;
• Alcohol, drug, and tobacco abuse during pregnancy;
• Infertility: The risk of germ cell neoplasms is increased in infertile men, probably due to common factors involved in both infertility and carcinogenesis. Furthermore, patients suspected of infertility undergo more examinations, ultimately increasing the number of early diagnoses;

Therefore, an annual specialized urological examination is indicated for all patients with these risk factors.

Regarding testicular trauma, there is no evidence that it can directly cause cancer. However, it is often a traumatic event that leads to diagnosis, thanks to the investigations carried out in relation to the trauma itself.

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Diagnosis of Testicular Cancer

Clinical Examination

The diagnostic process begins with palpation of the testicles, a quick and simple maneuver allowing the doctor to detect key diagnostic elements. These include:

• A progressive, sometimes rapid, increase in the size of a single testicle with generally painless hardening;
• The presence of smooth or rough, generally painless nodules on the surface of a testicle;
• A rough and irregular texture of the testicle;
• A feeling of tension, diffuse pain, or heaviness in the testicular or inguinal region, with increased tenderness to the touch;
• Hypersensitivity to the touch in the testicular region;

Following the examination, appropriate tests are prescribed.  

Testicular Ultrasound

In addition to determining the nature of a nodule, testicular ultrasound can differentiate solid nodules from cysts. Testicular ultrasound is completely harmless and painless, lasting only a few minutes.

Blood Tests

Tumors can release high amounts of certain substances into the bloodstream. These substances are called tumor markers, and their levels can be measured with a simple blood test. Normal values do not exclude the presence of the disease, while high values rarely, but possibly, indicate the presence of a tumor.

Magnetic Resonance Imaging (MRI)

In the very rare cases where ultrasound does not provide sufficient information on the nature of a nodule, magnetic resonance imaging (MRI) may be used. This radiological technique uses magnetic fields to provide a detailed image of an organ's internal structures. MRI use is very rarely indicated and is decided upon by the specialist.

Histological Examination

In the case of testicular cancer, a definitive diagnosis can only be obtained after analysis of the tumor tissue by histological examination.

The definitive histological examination, performed by a pathologist, identifies the histological type of the disease and other characteristics such as the invasion of tumor cells into neighboring tissues or small surrounding vessels. Based on the results of the histological examination, the doctor chooses the most appropriate treatment for the patient.

Treatments for Testicular Cancer

Surgery

If the tumor is diagnosed at an early stage, surgery to remove a testicle may be the only treatment needed, followed by close monitoring.

Removal of a testicle does not affect sexual function. If the patient is concerned about appearance, they can consult with urologists and decide to have a testicular prosthesis implanted in the scrotum.

If the cancer spreads beyond the testicles, a second surgical procedure, chemotherapy, or radiotherapy, or a combination of these therapies, may be necessary.

If the cancer has spread to the lymph nodes, abdominal lymph node dissection (retroperitoneal surgery) may be necessary. Removal of lymph nodes does not affect the patient's ability to have an erection or orgasm. However, this surgery can reduce fertility as it interferes with ejaculation.

Chemotherapy

In general, chemotherapy is very effective for testicular cancer. The need for chemotherapy depends on the type, stage, and size of the tumor. Some anticancer drugs interfere with sperm production: although many men regain their fertility, the effect is sometimes permanent.

Radiotherapy

In general, radiotherapy does not affect the patient's sexual ability. However, it can interfere with sperm production. This effect is generally temporary, and most men regain their fertility within a few months. However, before undergoing treatment, the patient may consider cryopreserving their sperm.

Prevention of Testicular Cancer

To prevent the onset of testicular cancer, from adolescence onwards, it is advisable to educate the patient about the usefulness and methods of testicular self-examination, to be performed monthly. In this regard, and as is the case for girls with gynecological examinations, it is extremely useful to subject boys to a uro-andrological examination, also because many anomalies and diseases of the genital system are not diagnosed or are diagnosed very late.

Patients with cryptorchidism have a 10 to 40 times higher risk of developing cancer than healthy men. If orchidopexy (surgical fixation of the testicle in the scrotum) was performed before the age of 6, the risk is reduced, while it increases if first-degree relatives have been diagnosed. According to some epidemiological studies, the use of estrogens during pregnancy may increase the predisposition to neoplasms in the unborn child. Alcohol and sedative abuse in the mother is also a significant risk factor.

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