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At Testicular cancer is a malignant tumor disease that occurs relatively rarely with less than two percent of all new cancer cases. Nevertheless, it plays an important role in men of young and middle age, because it is the most common new tumor in men. If cancer is discovered early, it can be cured permanently in most cases, and even in the metastatic stage, it is in contrast to many other malignant tumors have a good chance of healing. Accordingly, warning signals such as swelling and hardening in the testicles should always be taken seriously and examined by a doctor or urologist.
Testicular cancer: brief overview
Testicular cancer is particularly common among younger patients. Around 80 percent of those affected are under 50 years of age. In about 95 percent of all cases, the tumor only occurs in one of the two testicles. Here is a brief overview of the symptoms:
- Symptoms on the scrotum: Testicular swelling, testicular enlargement, knots or hardening, tension or pulling in the scrotum, sensitivity to touch, fluid accumulation.
- General symptoms: Chronic fatigue, decreased performance, loss of appetite, nausea, weight loss, back pain, difficulty breathing.
- Risk factors: Undescended testicles, abnormal development of the urethral opening, hereditary predisposition, cell changes in the testes (testicular intraepithelial neoplasia), infertility.
- diagnosis: Ultrasound examination, biopsy, computed tomography.
- therapy: Surgical removal of the testicle, then chemotherapy or radiation therapy may be required. Regular checks ensure that no further metastases form.
Testicular carcinoma: definition and frequency
In medicine, the term “testicular cancer” or “testicular carcinoma” refers to a malignant tissue growth that spreads in the man's testicle, but can also affect any other body organ via the bloodstream. Younger men between the ages of 25 and 45 are particularly affected, as this type of cancer is the most common malignant tumor. In general, however, testicular cancer is one of the rarer types of cancer, according to the Robert Koch Institute, and accounts for around 4 percent of all cancers among men with around 4,000 new cases each year.
Most people (95%) have cancer unilaterally. In addition, almost all tumors (90%) originate from germ cells ("germ cell tumors"). A distinction is made between tumors that originate from the testicular tissue or the so-called "spermatogonia" (seminomas) and the so-called "non-seminomas", which can consist of different types of tissue and are therefore more specific. B. be called yolk sac tumor or chorionic carcinoma. Both forms are roughly the same frequency, with non-seminomas developing somewhat earlier on average. Accordingly, the mean age at the onset of a non-seminomatous testicular tumor is 27 years and at seminomas 37 years.
The remaining 10% of malignant testicular tumors originate in the supporting tissue (“Sertoli cell tumors”), in the testosterone-producing cells (“Leydig cell tumors”) or in the lymphoid tissue of the testes (lymphomas). Daughter tumors (metastases) from tumors of other organs can also appear in the testes.
Testicular cancer symptoms
In most cases, clearly visible symptoms appear with this cancer variant, which is why a disease is usually discovered by those affected themselves. Typically, this is a predominantly one-sided testicular swelling, which gradually increases, but does not cause pain. In addition, there are often noticeable nodular hardenings, a feeling of pressure or heaviness in the testicles and a pulling in the groin. Some people also report testicular pain, swollen mammary glands, blood in the sperm, a decrease in sexual desire or an accumulation of fluid in the scrotum (hydrocele). In the advanced stage of the disease, back pain and shortness of breath can also occur due to swelling of the lymph nodes in the posterior abdomen.
However, swelling and hardening need not necessarily indicate cancer. Instead, benign diseases such as epididymitis or a so-called "twisted testicle" (testicular torsion) are often responsible for the symptoms. Nevertheless, the complaints should always be taken seriously and promptly clarified by a doctor or urologist in order to avoid health risks.
Testicular cancer causes
The causes of testicular cancer have not yet been fully clarified. However, some risk factors are known that can have a beneficial effect on the development. Above all, this includes a so-called "testicular undescended" (cryptorchidism), in which one or both testicles do not become in the scrotum after birth, but instead, e.g. located in the abdominal cavity or in the inguinal canal. It is the most common congenital malformation of the urinary and reproductive system, which occurs in almost one to three percent of mature male babies. Premature babies, on the other hand, are affected much more often because of their still immature development with up to 30 percent.
In some cases (approx. 7%) the testicle migrates into the scrotum by itself in the first months of life, but after the first year of life this process is very unlikely. If an undescended testicle is not treated early, the risk of reduced fertility (infertility), testicular torsion and a hernia increases. In addition, according to current studies, the risk of later development of a testicular tumor increases by two to three times. Since damage can occur within the first six to twelve months of life, experts today advise that the therapy be completed before the end of the first year of life. Accordingly, if the situation does not change automatically within the first six months of the year, attempts are made to treat the high level with medication by administering hormones. If there is no success, a small surgical intervention is usually necessary to change the position of the testicle.
In addition, hereditary factors are believed to be the cause of an increased risk of disease, since the tumor sometimes occurs frequently within a family. Accordingly, according to the German Cancer Aid, a case of testicular cancer in a family with several sons would lead to an approximately twelve-fold increased risk for the brothers. The same applies if the father is ill, because here too the risk of cancer for the son is higher than for peers without a family history.
Testicular cancer diagnosis
If there is a suspicion of testicular carcinoma, a thorough survey is usually carried out first, through which the doctor can get a first impression. It is therefore helpful to ask yourself questions in advance such as: "Since when has the swelling existed?" Or "What other complaints have occurred?" In order to be able to give the most accurate possible answers. This is followed by a precise examination of the testicles, through which the doctor can identify hardened or nodular areas, and an ultrasound examination (testicular sonography) also helps to make any changes visible.
A blood sample is often taken to confirm or invalidate the suspicion in order to provide information on possible “tumor markers” such as to obtain the protein alpha-fetoprotein (AFP) or the hormone human chorionic gonadotropin beta (ß-HCG). These are biological substances in the blood or other body fluids that, in increased concentration, can indicate the development or recurrence of malignant tumors.
If the suspicion is confirmed, the testis is usually exposed in the next step as part of an operation. In this way, the doctor can often already recognize whether it is a malignant tumor. For a clear diagnosis, however, the examination of a tissue sample from the affected testicle is necessary (biopsy). In order to check whether there is already a metastasis in other organs or a lymph node involvement, further imaging procedures are usually carried out, e.g. X-ray examinations or computer tomography (CT) are used.
Therapy for testicular cancer
If the diagnosis can be made clearly, the first step to treatment usually involves the surgical removal of the affected testicle including epididymis and spermatic cord via an incision in the groin (orchidectomy). The procedure, which is usually performed under general anesthesia, is considered to be relatively simple and risk-free. In addition, a small tissue sample can be taken from the healthy testicle during the operation in order to be able to discover a possible cancer precursor on the other side. Side effects or consequential damages such. Infertility or impotence only occur in very rare cases due to the removal of a single testicle, since the healthy testicle on the other hand compensates for the malfunction. In addition, for cosmetic reasons, an implant made of silicone (testicular prosthesis) can be used, which does not differ in appearance and feel from a healthy testicle.
The further treatment steps after the intervention depend on the type of tumor (seminoma or non-seminoma) and the form of the disease. In the case of tumors discovered early, a wait-and-see strategy is sufficient in many cases, in which no further therapy is carried out for the time being. Here, however, very short-term checks are necessary in order to detect possible metastasis formation at an early stage. Alternatively, depending on the stage of the disease, a “Seminoma” type of cancer uses radiation or different chemotherapeutic procedures.
In the case of a non-seminoma, however, radiation therapy is normally not carried out, since this type of tumor is less sensitive to radiation. Instead, after waiting for the testicle to be removed depending on the stage of the disease, the wait-and-see surveillance strategy or chemotherapy can also be considered. In this case, additional operations may be required to remove lymph nodes in the posterior abdominal cavity or metastases in individual body organs
If the testicular cancer is discovered and treated accordingly, the prognosis is usually good. However, it is important to be recognized and treated as early as possible, because in this case more than 95% of the testicular tumors can be permanently cured. In contrast to most other malignant tumors, there is also a good chance of a cure for an advanced disease, which, according to the Robert Koch Institute, means that the relative 5-year survival rates are 97% high and the mortality rate is low with 170 deaths per year.
Testicular cancer prevention: Correct palpation is important
To prevent malignant tumor disease, every man should scan both testicles for changes about once a month. This is especially true if the risk is greatly increased due to undescended testicles or hereditary predisposition from a sick father or brother. In addition, your own examination should start at puberty, since testicular cancer occurs primarily in very young men. The palpation is simple and uncomplicated if the scrotum is held with the palms of the hands and touched with the fingers of both hands at the same time. Each testicle should be palpated individually and thoroughly examined for changes.
While a healthy testicle usually has a smooth surface, testicular cancer is usually manifested by hardening or painless enlargement of an entire testicle, often affecting only one side. If something is noticed during the check, you should not hesitate to see a doctor immediately. This is particularly important because testicular cancer can be cured the sooner it is discovered. In addition, other changes such as Varicose veins of the testicles (varicoceles) are discovered in this way and treated if necessary.
However, there is no special early diagnosis check-up with the health insurer at the doctor's expense. Nevertheless, experts advise men aged 20 and over to have a urologist's annual touch test to identify a possible disease at an early stage. Affected people who have already been treated for testicular cancer should definitely go for follow-up care. Because even if relapses occur relatively rarely, it is important to avoid health risks and to have the state of health checked regularly. (No)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Social Science Nina Reese
- German Cancer Society: Testicular cancer (accessed: August 26, 2019), krebsgesellschaft.de
- Austrian Cancer Aid Cancer Society: Testicular cancer (accessed: August 26, 2019), krebshilfe.net
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- Swiss Cancer League: Testicular cancer (accessed: August 26, 2019), krebsliga.ch
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- Guideline program oncology: S3 guideline diagnostics, therapy and aftercare of the germ cell tumors of the testes, version 1.0, status 2019, leitlinienprogramm-onkologie.de
ICD codes for this disease: C62ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.