Malignant tumors of testicles or testicular cancer – cancer, neoplasms of male scrotum. Testicular tumors are quite rare and mostly in children (about 30% of all tumors of childhood) and young people. In general, for men, testicular tumors account for about 1% of all malignant neoplasms.
Main factors contributing to their development are:
- Testicular injury.
- Kleinfelter syndrome.
- Microwave, x-ray and gamma radiation.
Tumors such as seminoma, fetal testicular cancer, yolk sac tumor, polyembrioma, teratoma, and chorionic carcinoma most often develop. Histological type of tumor can be one of listed or mixed.
Degree of differentiation of tumor may also be different. Distinguish between germ cell (embryonic origin) and non-germ cell tumors, and in adults proportion of germ cell tumors accounts for 95% of cases. These include seminoma – testicular cancer, which develops from spermatogenic epithelium. Nonseminar tumors are most often of mixed origin. Combination of teratoma + fetal carcinoma is most common. Most aggressive course is choriocarcinoma.
What is useful to know?
Local spread of testicular tumors is manifested by increase in size of testicle, germination in its other parts (appendage, spermatic cord, testicular membrane). At this stage (when there are no nearest and distant metastases) about 40% of patients can be identified. It`s for this group and results of treatment are most favorable.
Regional metastasis of testicular tumors along lymphatic ducts is characteristic of retroperitoneal lymph nodes and much less frequently in inguinal or pelvic. Hematogenous metastasis is most common in lung tissue.
Test of testicular tumor usually begins with detection of one-sided dense nodule, increase in size, or change in shape of testicle or scrotum. At initial stage, tumor is usually painless, but as it grows, pain appears both in testicle and along spermatic cord. You may experience pain in lower abdomen, due to metastasis to regional lymph nodes. Distant metastases give clinical manifestations in corresponding organs and tissues. In presence of hormonally active tumor, changes in secondary sexual characteristics appear: gynecomastia (breast enlargement), early puberty, hirsutism (excessive hair growth), etc.
Primary diagnosis is reduced to inspection and palpation of testicles, palpation of lymph nodes, examination of mammary glands. Simplest and at the same time well-informative instrumental study includes diaphanoscopy (translucent testicle by narrow beam of light).
Medical imaging methods are widely used: ultrasound, computed tomography, magnetic resonance imaging, X-ray contrast methods. They allow not only to identify presence and characteristics of tumor growth, but also to assess surrounding tissues, which allows to detect presence of nearest and distant metastases. Special attention is paid to definition of specific tumor markers:
- Cancer embryonic antigen.
Sometimes lactate dehydrogenase is also referred to listed markers. Appearance of all these markers in diagnostic significant quantities indicates activation of oncogenes and tumor process as a whole.
Treatment of cancer and other malignant testicular lesions is usually complex. Combination of radiation therapy with surgery and chemotherapy gives best results today. Quality of treatment depends primarily on timeliness of tumor detection, radical removal of primary focus, preoperative irradiation, removal of regional lymph nodes, and postoperative chemotherapy.
Each of stages has its own characteristics, depending on type of tumor. Thus, germ cell tumors (especially seminoma) respond better to primary radiation therapy, and some types of tumors are rather successfully treated only by surgery. Prevention of malignant tumors of testicle is reduced to prevention of those factors that contribute to their development, especially cryptorchidism, injuries and radiation of genitals.