Tumors of the testicles – types, causes, symptoms, treatment

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Testicular tumors are malignant tumors that most often occur in young men between 16 and 27 years of age. Non-descent of the testicle or recurrent infections may be factors contributing to the development of the disease. In the case of this ailment, self-examination is important, which in many cases allows for a quick diagnosis and implementation of appropriate treatment. Treatment usually includes removal of the testicle, lymph nodes and appropriate chemotherapy.

What are the testicles?

The testicles are two male reproductive organs located in the scrotum. The testes produce sperm and the male sex hormones in the form of testosterone. In addition, within the scrotum, the man has nerves and blood vessels that run through the testicles and the drainage tube.

In turn, the epididymis are located above the testicle, in the vicinity of which sperm are stored. In anatomical structure, there is also a seminal cord, thanks to which the testicles are suspended in the scrotum, but also all wires, nerves and vessels are located in it.

Find out how to properly examine the testicles at home

Tumors of the testicles – types

Types of testicular tumors (depending on the type of cells from which the abnormal tumor growth comes:

1. seminoma – the most common malignant tumor that originates in sperm-producing cells (they account for 25 to 50 percent of all testicular tumors and are more common in men aged 25 to 45),
2. germ cell cancer,
3. teratoma,
4. chorionic mucosa.

The causes of testicular cancer

The causes of cancer are not fully understood, but may be related to heredity. The factors contributing to the occurrence of cancer include:

1. recurring infections – inflammation of the testicles and epididymides occurs when bacteria and viruses reach them together with blood from another inflammatory focus. Testicular inflammation in young boys often occurs as a complication of a history of mumps. Ignoring this type of infection increases the risk of developing cancer up to 10 times, so it is worth taking care of appropriate treatment and breaking the shame;
2. a history of testicular cancer – a history of testicular cancer may increase the risk of a new disease by 500 times (there is a chance that in a group of 1 to 2 percent of those treated, the other testicle will develop a tumor); 
3. past inguinal hernia surgery;
4. non-descent of the testicle into the scrotum – under normal conditions, the testicles from the abdominal cavity pass through the inguinal canal into the scrotum and in a newborn both these glands are usually in place. However, there are situations where the testicle stops during the journey, but before the first year of life it reaches the scrotum by itself. However, if such a situation does not occur, you should go to a doctor who will select the appropriate type of hormonal or surgical treatment. Parents should remember that the testicles should be in the scrotum before the boy is two years old, then the chance of having a child is much greater and the risk of cancer is lower (a history of cryptorchidism may increase the risk of a new disease 20-40 times, i.e. there are as many as 10 percent probability that the tumor will develop in a descended testicle);
5. abnormal course of pregnancy in the mother – excess estrogen in the parent’s body at the time the boy’s testicles are forming – is harmful. Where does this excess come from? It may be related, for example, to the treatment of female infertility;
6. a genetic predisposition like testicular cancer in the family (especially in a father or brother);   
7. it was noted that the cancer appeared in men whose giving births were more than 35 years old;
8. congenital genetic defect syndrome e.g. Klinefertel syndrome or androgen insensitivity syndrome;   
9. testicular development disorders;
10. white race – males of this race suffer up to four times more often than black males. However, black men with testicular cancer are more likely to die of cancer than white men, especially if the cancer has spread to lymph nodes or other parts of the body at the time of diagnosis; 
11. abnormalities in the activity of sperm-forming tubules in the area of ​​the testicle,
12. other factors: polluted environment, sedentary lifestyle, HIV infection.

Several studies have found that tall men have a slightly higher risk of testicular cancer, but other studies have not confirmed this. Most studies have found no link between testicular cancer and body weight.

Tumors of the testicles – symptoms

Patients with testicular cancer are characterized by a painless, hard tumor that can be felt in the testicle. In addition, there is swelling and fluid within the scrotum, which gives a feeling of weight and crowding around the testicle.

There are situations where the first symptoms are those that indicate metastasis:

1. back pain,
2. abdominal pain,
3. blood plucking,
4. tumor present in the supraclavicular region,
5. enlarged lymph nodes in the retroperitoneal space (visible on ultrasound),
6. sometimes gynecomastia.

Diagnosis and treatment of testicular cancer

Successful cure and prognosis for life depend on early diagnosis. Therefore, it is very important to self-test during daily hygiene procedures. If a man notices an enlarged, uneven, lumpy, hard, painless, and characteristically heavy testicle, he should immediately consult a urologist. For the sooner we enter treatment, the better the patient has a chance of survival.

Testicular cancer is diagnosed with a physical examination, an ultrasound examination can also be performed. In some types of testicular cancer, male breast enlargement, the so-called gynecomastia.

Initially, the doctor performs tests to confirm the presence of a tumor in the testicle. The tests performed in diagnostics include:

1. blood test to check the presence of tumor markers (e.g. beta-HCG; LDH, AFP),
2. Testicular ultrasound,
3. Abdominal ultrasound,
4. computed tomography of the chest.

As for tumor markers, they are assessed for the possible removal of the testicle together with the tumor. The very examination of tumor markers allows not only the diagnosis of cancer, but also the degree of its advancement.

Treatment of testicular tumors

Treatment of testicular tumors is usually combined with removal of the testicle along with the spermatic cord, removal of the peraortic lymph nodes, and appropriate chemotherapy. Some types of testicular cancer involve removal of the testicle and irradiation of the lymph nodes.

After the testicle is removed, it is assigned a specific stage, depending on the stage of the neoplastic process as well as microscopic and clinical evaluation.

1. Grade 0 – it is a non-invasive neoplasm, neoplastic lesions are located in the area of ​​sperm-producing tubules, and the number of tumor markers remains normal.

2. Grade I – indicates that cancer has already arisen from single cells.

3. Grade II – is divided into sub-stages IIA, IIB and IIC (the cancer affects the lymph nodes inside the abdomen). Stage IIA neoplasm is located around the testicle, scrotum, and the spermatic cord and some lymph nodes. Tumor markers are slightly increased.

4. Stage III – we divide in turn into subordinate IIIA, IIIB and IIIC. The first case means that the tumor has attacked the scrotum, testicle, seminal cord and some lymph nodes in the abdominal cavity or those more distant. Grade IIIB is similar to IIIA but the concentration of markers (one or more) is increased. However, the IIIC stage, apart from the involvement of the testicle, cord and scrotum, is characterized by the involvement of the lungs or distant lymph nodes and, importantly, tumor markers are above the norm.

The very removal of the testicle is performed through an incision in the groin through which the entire testicle is removed together with the cord. The surgeon does not perform a histopathological examination during the operation so as not to contaminate the wound with cancerous cells. There are cases when it is necessary to perform laparoscopic or traditional surgery to excise the remnants of the tumor-occupied retroperitoneal lymph nodes.

After the stage of the disease has been determined, the appropriate type of treatment with the use of radiation or chemotherapy is introduced.

In patients with testicular non-seminomatous tumor, the lymph nodes in the abdominal cavity changed by the tumor should be excised or a fragment obtained for histopathological examination. In contrast, in seminomas, treatment is based on radiation therapy, but surgery may also be needed to assess the effectiveness of ionizing radiation.

Unfortunately, testicular cancer may come back many years after treatment has ended. It can attack the second testicle or other body area. It is important to follow medical recommendations and perform periodic check-ups.

Be sure to read: What does the pain in the right testicle show?

Testicular neoplasms – prognosis

The prognosis for testicular cancer is quite good. The prognosis depends on the severity of the disease, and so in the case of an early stage of disease, practically all patients have a chance of a permanent cure. For patients with advanced stages of testicular cancer, most survive 5 years after diagnosis. In 1-year patients with seminoma, the survival of stage 5 is 100 percent, in stage II – from 70 to 90 percent, and in stage III of testicular cancer – 70 percent.

Testicular cancer – epidemiology

Testicular tumors are one of the most common malignant neoplasms in men aged 20 to 44 years and the incidence continues to rise (it has increased more than 3 times in the last three decades). Every year, there are over 1000 new cases of testicular cancer (2017 were diagnosed in 1156).

It is estimated that about 100 patients die each year from a testicular tumor. Seminomas make up 40 percent, and non-seminomas make up 60 percent of all testicular cancers.

Testicular cancer – prophylaxis

Prophylaxis consists in self-examination of the testicles. Some doctors advise men aged 15 to 55 to do a monthly self-examination to check for any changes. Monthly self-examination of the testicles after a warm shower can help detect cancer at an early stage, when it is most likely to be cured. Men who notice a lump, induration, enlargement, pain, or any other change in one or both testicles should see a doctor immediately.

To perform a self test of the testicles, follow these steps:

1. Do your self-examination after a warm shower or bath. The heat relaxes the skin of the scrotum, making it easier to feel for anything that may be of concern.

2. Use both hands to thoroughly examine each testicle. Place your index and middle fingers under the testicle and your thumbs on top. Then roll the testicle between your thumbs and fingers.

3. When you examine the testicle, you may notice a string-like structure on the top and back of the testicle. This structure is called the epididymis. It stores and transports sperm. Don’t confuse it with a lump.

4.Try to feel any lumps you may have. The lumps can be the size of a pea or larger, and are often painless. If you notice a lump, see your doctor.

Find out more: Testicular self-examination and cancer. How to Examine the Testicles?

Testicular Tumors – Side Effects of Treatment

Removing one testicle does not affect a man’s ability to have an erection, orgasm, or conceive children – one testicle can do both. There are implants that replace the removed nucleus that feel the same to the touch and weigh the same as the original.

Removal of lymph nodes has no effect on erections and orgasms, but may cause infertility as surgery disrupts the nervous mechanics of ejaculation. Men undergoing this type of surgery should ask their doctors about alternative solutions that can spare them nerves.

Radiation therapy, in turn, affects not only these sick, but also healthy cells, which, however, can recover. Radiation therapy does not affect sexual performance, but it can temporarily damage sperm production, usually for several months. Physical side effects include fatigue, diarrhea, and nausea. Some skin irritation is possible and lotions can help.

When it comes to chemotherapy, this one causes the most serious side effects. These include hair loss, loss of appetite, decreased immunity, nausea, vomiting, and mouth ulcers. Chemistry also affects sperm production. Some men recover after several years; for others, infertility is permanent.

It should be added that every man treated for testicular cancer is monitored over several years to make sure that the disease has completely disappeared.

How to deal with the diagnosis of testicular cancer?

Knowing that you have cancer is difficult. A person is tormented by emotions such as confusion, fear, numbness, denial, and anger. Some men isolate themselves, causing only further harm to themselves and their loved ones. Init is important to discuss your concerns with family, doctors and friends. This alleviates fears and makes it clear that you are not alone with this. However, it is the sick person himself who must start the dialogue. Forcing a man to open up can be counterproductive.

Support groups and psychologists are a trusted source of information and comfort that should be freely consulted. Above all, however, a man should have the courage to seek help when he discovers that he has cancer and to soothe his loved ones. It is important if the disease was diagnosed at an early stage, where there is a very good chance of a cure, anyway Lance Armstrong is living proof that testicular cancer can be cured.

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